Abstract 4344341: Sex- and Race-Based Disparities in Outcomes Following TAVR in Heart Block Patients Requiring Pacemaker Implantation

Abstract

Background: TAVR is increasingly offered for treatment of aortic stenosis with over 100,000 procedures performed annually in the US. Advanced heart block is a known complication that requires permanent pacemaker implantation. While disparities in cardiovascular outcomes by race and sex are well-documented, an analysis of both variables simultaneously offers a more nuanced and practical description of these disparities. In this study, we introduce a composite race-sex variable—using White males as the reference category—to assess differential outcomes in TAVR patients developing advanced atrioventricular block (AVB) requiring a permanent pacemaker (PPM). Methodology: We conducted a retrospective cohort study using the 2021 national inpatient sample database, a survey weighted, nationwide sample with over 6 million observations across the US. Post TAVR patients (identified using ICD-10 codes) comprised our patient population. The primary outcome was AVB (Type II mobitz and third degree) necessitating pacemaker insertion and all-cause mortality. The primary exposure variable was a 12-level composite of gender and race values (1= white male to 12=other female). Logistic regression was employed to calculate crude and adjusted OR calculated for AVB and all cause mortality (primary outcome) adjusting for demographics and comorbidities using Charlson comorbidity index. Results: Among the 86,840 patients who underwent TAVR, 4.32% (n=3751) developed heart block requiring pacemaker insertion. Mean age of the cohort was 77.8 years with 42.1% identifying as female. Overall in-hospital mortality was 1.05%. Adjusted for age and comorbidity the all-cause mortality was 1.5 times higher for white females (OR:1.48, CI:1.05-2.07, p=0.02) and 3.5 times higher for hispanic females (OR:3.5, CI:1.7-6.8, p=0.00) when compared to white males. However, no statistically significant difference was found between the groups in the incidence of AVB requiring PPM placement. The logistic regression model demonstrated moderate discrimination with an area under the ROC curve (AUC) of 0.69. Conclusion: White and Hispanic females experience significantly increased all-cause mortality following TAVR compared to white males, despite similar rates of heart block and PPM implantation. These findings underscore the importance of considering intersectional race-sex variables when evaluating outcomes and may inform more equitable preprocedural risk stratification and post-procedure care strategies