Abstract 113
Racial Comparisons in the Outcomes of SAVR and TAVR
- McNeely, Christian
- Zajarias, Alan
- Fohtung, Raymond
- Robbs, Randall
- Markwell, Stephen
- Vassileva, Christina
Background: Racial disparities in the outcomes after intervention for aortic valve disease remain understudied.
Methods: Data of patients who underwent surgical (SAVR) and transcatheter aortic valve replacement (TAVR) were obtained from the Medicare database from Nov 2011 through 2013. Comparisons were performed stratifying by race.
Results: In the TAVR group, there were 17,081 (95.0%) white patients and 706 (3.9%) African Americans (AAs). In SAVR, there were 89,265 (93.9%) whites and 4,562 (4.8%) AAs. Compared to whites, AAs were substantially younger in both TAVR and SAVR groups. Otherwise, most comorbidities were more common among AA (Table 1).
In TAVR, mortality at 30 days and 1 year was similar for AA patients and whites (6.1% and 6.3%, p=NS, and 20.5% vs. 22.3%, p=NS), respectively, while it remained higher in the SAVR cohort among AAs (6.2% vs. 4.7%, p=.0001, and 16.1% vs. 11.7%, p=.0001). Similarly, in TAVR, 30-day readmission was similar for AAs compared to whites (22.8% vs. 23.8%, p=NS) but remained higher for AAs after SAVR (25.2% vs. 20.1%, p=.0001). After adjustment for baseline characteristics, there was no statistically significant difference in 30-day mortality after SAVR between, races, however, AAs continued to have higher adjusted odds of readmission (OR 1.14, 95% CI 1.04-1.22). Compared to whites, AA patients were less likely to be discharged home after SAVR (52.1% vs. 57.7%, p=.0001), but not after TAVR.
Conclusions: While AAs have worse outcomes in SAVR, it appears that race does not impact mortality, readmission, or discharge to home in TAVR. While these results may be influenced by patient selection and incomplete adjustment, they are representative of outcomes observed in current clinical practice.