Racial, ethnic and socioeconomic disparities in patients undergoing transcatheter mitral edge-to-edge repair. (1st December 2021)

• Record Type: Journal Article
• Authors: Sparrow, Robert T.; Sanjoy, Shubrandu S.; Lindman, Brian R.; Tang, Gilbert H.L.; Kaneko, Tsuyoshi; Wasfy, Jason H.; Pershad, Ashish; Villablanca, Pedro A.; Guerrero, Mayra; Alraies, M. Chadi; Choi, Yun-Hee; Sposato, Luciano A.; Mamas, Mamas A.; Bagur, Rodrigo
• Is Part Of: International journal of cardiology. Volume 344(2021)
• Page Start: 73
• Page End: 81
• Publication Date: 2021-12-01
• Subjects: Racial disparities -- Socioeconomic inequality -- Transcatheter mitral valve repair -- Mitral valve regurgitation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.09.037
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER. Methods: Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke. Results: 3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100, 000, compared to 29.7/100, 000 for Blacks and 30.5/100, 000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups ( P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67–1.05 and OR: 0.84, CI:0.66–1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99–1.42). Conclusion: In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes. Brief summary: This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes. Graphical abstract: Unlabelled Image Highlights: This study appraises racial/ethnic and socioeconomic differences in outcomes after transcatheter mitral edge-to-edge repair. Blacks and Hispanics underrepresented, but less so compared to other transcatheter-based structural heart interventions. Black patients had a higher comorbidity burden and death rate, but similar total complication rate as compared to Whites. Further work is needed to better characterize the causes and mechanisms of these racial and socioeconomic disparities.