ACC 2019: Disparities persist in treatment of symptomatic aortic valve stenosis

March 16, 2019 — New research shows that although racial disparities have diminished in recent years, gender disparities are still common.

New DCRI research on severe, symptomatic aortic valve stenosis shows that black non-Hispanic patients have historically received treatment less frequently than their white counterparts, while women received treatment less frequently than men.

Because the disease has a mortality rate of up to 80 percent in five years, treatment is especially important. However, said J. Matthew Brennan, MD, MPH, who led the study, more than two-thirds of the patient population studied received no treatment.

The study’s findings were presented Saturday at the annual Scientific Sessions of the American College of Cardiology in New Orleans.

The team used the Optum database, which includes insurance claims from 700 hospitals and 7,000 clinics, as a data source. Using natural language processing of physician notes, they identified 43,822 patients with severe aortic valve stenosis between 2011 and 2016.

Disparities existed within the proportion of patients who received treatment. Through the beginning of the study period, African-Americans were less likely to receive treatment than white patients (about 27 percent versus nearly 35 percent), but the treatment rates have become more level over the past couple years, with no remaining significant difference in the likelihood of treatment.

The team hypothesizes that this is because of the increasing availability of transcatheter aortic valve replacement (TAVR), which arrived on the market in 2011. Now, patients have a less invasive treatment option than the traditional surgical aortic valve replacement (SAVR).

“We saw the greatest increase in treatment in the use of transcatheter therapies,” Brennan said. “It’s been reported widely that African-Americans tend to be less likely to accept invasive procedures, especially as they get older, as compared with whites. With the availability of a less invasive treatment option, we’re starting to see blacks catch up with whites because they’re accepting the treatments more.”

Although treatment ratios eventually leveled between races, disparities persist along gender lines, said DCRI Co-Chief Fellow Angela Lowenstern, MD, who was also a part of the study team. Women were less likely to be treated than men (28.7 percent of women were treated, while 36 percent of men were), but when they were treated, they were more likely to receive TAVR than men were (39.8 percent of women were treated with TAVR versus 32.3 percent of men).

The group also looked outcomes in these populations based on survival rates after one year. There were no significant differences between survival in blacks and whites, regardless of treatment type; even untreated patients from both races fared similarly, although survival was less likely for these groups. Women who received treatment had worse outcomes than men who were treated, which was driven primarily by low survival rates of women who received SAVR.

“The biggest next step is figuring out how we minimize these disparities that still exist,” Lowenstern said. “What can we implement, what are things that we can do to equalize the treatment of both male and female patients?”