Despite similar prevalence of aortic stenosis, utilization rates of life-saving aortic valve

replacement therapy were much lower in women and blacks compared with men and whites,

respectively in the US during 2012-2017. 1-year mortality rates for TAVR improved across all

subgroups during the study period.

Aakriti Gupta, Yun Wang, Torsten Vahl, Ajay Kirtane,

Makoto Mori, Isaac George, Susheel Kodali, Martin Leon, Harlan Krumholz

NewYork-Presbyterian Hospital and the Columbia University Irving Medical Center, New York, NY, USA Yale-New Haven Hospital, New Haven, CT, USA

RESULTS

Study population From 100% Medicare Fee-for-Service beneficiaries hospitalized between 2012 and 2017, we included patients with ICD-9 and 10 procedure codes for TAVR and SAVR. Outcomes We report operative rates per 1 000 000 person-years and outcomes including in-hospital mortality, discharge disposition, length-of-stay (LOS) and 1-year mortality rates stratified by sex and race.

The availability of both transcatheter and surgical aortic valve replacement (TAVR and SAVR) has revolutionized the care of elderly patients with aortic stenosis, particularly since TAVR was first approved in 2011. It remains unknown, however, whether dissemination of this technology has been equitable.

•  Rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites, respectively, and the difference was more pronounced for SAVR with rates in women half that in men, and blacks half that in whites (Figure).

•  In-hospital and 1-year mortality improved for all subgroups through the study period.

•  Compared with men, women had consistently worse in-hospital mortality but better 1-year mortality rates for TAVR. For SAVR, both in-hospital and 1-year mortality rates were worse in women.

•  While 1-year mortality rates were comparable between white and black patients undergoing TAVR, black patients undergoing SAVR had consistently worse 1-year mortality rates compared with whites.

•  Women and blacks were more likely to be discharged to skilled nursing facilities compared with men and whites, respectively.

•  Length-of-stay for TAVR improved for all subgroups through the study period.

CONCLUSION

METHODS

FIGURE 3

Sex- and Race-based Differences Among Medicare

Beneficiaries Undergoing Transcatheter and Surgical

Aortic Valve Replacement in the United States, 2012-2017

•  Utilization rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites during the study period

•  While outcomes for SAVR remained stable, in-hospital outcomes and 1-year mortality related to TAVR improved for all subgroups through the study period.

•  Efforts to minimize treatment disparities should focus on mitigating barriers to both TAVR and SAVR.

To examine race- and sex-specific trends in utilization and outcomes for Medicare beneficiaries receiving TAVR and SAVR during 2012-2017

OBJECTIVE

BACKGROUND

IN-HOSPITAL OUTCOMES

DISCLOSURE INFORMATION

16 27

38 53

73

90 82 80 73

67 58

49

22 35

52

70

101

125

156 160 151

142 128

112

2012 2013 2014 2015 2016 2017

Sex-specific AVR hospitalization rates per 100,000

Female_TAVR Female_SAVR Male_TAVR Male_SAVR

8 12 18

25 35

45

21

34

49

67

96

118

50 48 47

44 37 35

126 127 119 111

99

85

2012 2013 2014 2015 2016 2017

Race-specific AVR hospitalization rates per 100,000

Black_TAVR White_TAVR Black_SAVR White_SAVR

13.2 13.9

10.4 12.5

14.1 10.8

10.7 10

8.1 9.1 8.5 8.4

17.6

15.2

12 13.5

12.4 11

20.6

17.3

11.8 13.6

11.1 10.1

2012 2013 2014 2015 2016 2017

Race-specific 1-year mortality (%) SAVR_Black SAVR_White TAVR_Black TAVR_White

11.7 11

9.3 10.2 9.8 10 10.2

9.6 7.5 8.6 8.1 7.6

19.6 16.5

11.5 12.5

10.2 9.3

21.2

17.8

12

14.4 12

10.7

2012 2013 2014 2015 2016 2017

Sex-specific 1-year mortality (%) SAVR_female SAVR_male TAVR_female TAVR_male

Dr. Gupta is supported by NIH training grant T32 HL007854. Dr. Gupta reports consulting fees from Edwards Lifesciences and received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook inferior vena cava filter litigation. Dr. Gupta holds equity in a healthcare telecardiology startup, Heartbeat Health, Inc.