Abstract 4364146: Racial Disparities in Transcatheter Aortic Valve Replacement Utilization and Outcomes in the United States: A National Analysis (2016–2021)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a groundbreaking therapy for the management of severe aortic stenosis. Racial disparities in cardiovascular care including aortic stenosis however remain prevalent. Our study aims to investigate national trends in TAVR utilization and inpatient outcomes by race. Methods: We conducted a retrospective analysis of TAVR procedures from 2016 to 2021 using the NIS database. Patients were categorized by race (White, Black, Hispanic, Asian). Trends in TAVR utilization were evaluated using adjusted predicted probabilities. In-hospital outcomes, including mortality, acute kidney injury (AKI), myocardial infarction (MI), stroke, major bleeding, mechanical complications(breakdown, displacement, leakage) and cardiac arrest were compared using multivariable logistic regression, adjusting for age, sex, insurance, comorbidity index, income, and region. Results: A total of 319,085 TAVR procedures were identified from 2016–2021 (White: 286,265; Black: 13,070; Hispanic: 15,355; Asian: 4,395). While TAVR utilization increased across all racial groups during the study period, the adjusted predicted probability of undergoing TAVR was consistently highest for White patients and lowest for Black patients. After multivariable adjustment, Hispanic patients had significantly higher odds of inpatient mortality (aOR 1.68;95%CI 1.28–2.21), AKI (aOR 1.42;95%CI 1.21–1.66), and MI (aOR 1.45;95%CI 1.16–1.81) compared to White patients. Black patients had higher odds of AKI (aOR 1.25;95% CI 1.09–1.43). No significant differences were observed for stroke, major bleeding, mechanical complications, or cardiac arrest among the racial groups after adjustment. Conclusion: Despite an overall increase in TAVR utilization, there remains significant racial disparities in both access to and outcomes of TAVR in the US. Black patients were noted to have the lowest rates of TAVR utilization. Hispanic patients experienced significantly higher adjusted odds of inpatient mortality, AKI, and MI, while Black patients also had higher odds of AKI during the study period. These findings highlight the need for focused interventions aimed at addressing underlying factors contributing to these disparities and ensuring equitable TAVR use.