Author + information
- Received May 28, 2019
- Revision received August 19, 2019
- Accepted August 27, 2019
- Published online January 20, 2020.
- Jimica B. Wilson, BSa,
- Larry R. Jackson II, MDb,
- Francis E. Ugowe, MDc,
- Terrell Jones, BSd,
- George S.A. Yankey Jr., MDc,
- Colin Marts, BAd and
- Kevin L. Thomas, MDb,∗ ()
- aAlbany State University, Albany, Georgia
- bDuke Clinical Research Institute, Durham, North Carolina
- cDuke University Medical Center, Durham, North Carolina
- dDuke University Medical School, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Kevin L. Thomas, Duke Clinical Research Institute, 200 Morris Street, Durham, North Carolina 27705.
• Data on the management and outcomes of diverse populations with severe AS are lacking.
• Underrepresented racial/ethnic groups have lower rates of AVR and worse outcomes.
• Studies assessing reasons for lower AVR and strategies/interventions are needed.
Aortic stenosis (AS) is among the most common valvular heart diseases encountered in the United States. In this review the authors examine differences between racial and ethnic groups in the epidemiology and management of severe AS, explore potential explanations for these findings, and discuss the implications for improving the delivery of care to racially and ethnically diverse populations. Underrepresented racial and ethnic groups experience a paradoxically lower prevalence or incidence of AS relative to white subjects, despite having a higher prevalence of traditional risk factors. Historically, UREGs with severe AS have had lower rates of both surgical and transcatheter aortic valve replacement and experienced more post-surgical complications, including, bleeding, worsening heart failure, and rehospitalization. Last, UREGs with severe AS have an increased risk for morbidity and mortality relative to white patients. To date much of the research on AS has examined black-white differences, so there is a need to understand how other racial and ethnic groups with severe AS are diagnosed and treated, with examination of their resulting outcomes. Overall, racial and ethnic disparities in health care access and care delivery are a public health concern given the changing demographics of the U.S. population. These differences in AS management and outcomes highlight the need for additional research into contributing factors and appropriate interventions to address the lower rates of aortic valve replacement and higher morbidity and mortality among UREGs.
This research was not supported by agencies in the public, commercial, or not-for-profit sectors. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2019.
- Revision received August 19, 2019.
- Accepted August 27, 2019.
- 2020 American College of Cardiology Foundation
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