Demographic Analysis of a Single Center Transcatheter Aortic Valve Replacement Practice Reveals Racial Disparities in Access to New Medical Technologies.

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Demographic Analysis of a Single Center Transcatheter Aortic Valve Replacement Practice Reveals Racial Disparities in Access to New Medical Technologies Prashanth Vallabhajosyula MD, Rohan Menon BS, Laura Gallagher BA, Emil Pitkin BS, Wilson Szeto MD, Howard Herrmann MD, Jay Giri MD, Saif Anwaruddin MD, Lisa Walsh RN, Madeleine Walsh BA, Joseph Bavaria MD. University of Pennsylvania, Philadelphia, PA, USA

*As the largest regional provider of transcatheter aortic valve replacement (tAVR) technology for the treatment of aortic stenosis, anecdotal evidence suggested low minority enrollment for TAVR in an area with significant minority population. *Per Yueng et al, studies have found that rates of Aortic stenosis in Caucasians and minorities are relatively the same, yet health disparities exist when it comes to the treatment of the disease(2013). *In this context, we explored the racial demographics of our TAVR referral practice in order to better understand the extent of minority under-representation for this new treatment modality. Objective

* From , 1361 TAVR referrals were made to the Hospital of University of Pennsylvania. * Patient demographics including race, gender, insurance information, and patient residence were retrospectively reviewed from a prospectively maintained database. *Minorities were defined as those with African American, Asian, or Hispanic heritage. Methods

Figure 1:SES TAVR Referrals Flow Chart

Figure 2: Medicare Representation for PA and NJ in comparison to National Averages MEDICARE REPRESENTATION

*Of 1361 referrals, only 44 patients(3.2%) were minorities. *98% of minorities and Caucasians referred for TAVR resided in either Pennsylvania, New Jersey, or Delaware. *474 Caucasians (36%) and 13 Minorities(30%) underwent TAVR. *1125 Caucasians(85%) and 35 Minorities(80%) listed Medicare as primary insurance. *Patient insurance did not influence whether referred patient underwent TAVR(85%,n=414) versus no TAVR(86%,n=750). *Majority of minority patients were African American(91%,n=40). Hispanic representation was especially low(5%,n=2). Summary of Results

*Similar percentages of the referred Caucasians and Minorities underwent TAVR; Therefore, once referred, minority access to TAVR treatment modality was similar to Caucasians. *Similar percentages of the Caucasians and Minorities that underwent TAVR listed Medicare as their primary insurance. *Our study suggests significant under-representation of minorities in enrollment for the new and emerging medical technology of TAVR. *Although the causes for this discrepancy are likely multi-factorial, our study demonstrates the importance of reaching out to minority communities and their physicians to increase medical education and awareness of TAVR technology. Conclusions

Yeung, M., Kerrigan, J., Sodhi, S., Huang, P. H., Novak, E., Maniar, H.,& Zajarias, A. (2013). Racial Differences in Rates of Aortic Valve Replacement in Patients With Severe Aortic Stenosis. The American Journal of Cardiology, 112(7) Retrieved from References