title: Racial differences in rates of aortic valve replacement in patients with severe aortic stenosis.
abstract: Racial disparities exist in the treatment of many cardiovascular diseases. Aortic valve replacement (AVR) is the only treatment for aortic stenosis (AS) that improves patient symptoms and survival. To date, no studies have compared the rate of AVR among different races. The records of patients with an aortic valve area <1 cm(2) by echocardiography diagnosed between January 2004 and May 2010 at Barnes-Jewish Hospital were reviewed retrospectively. Patients were stratified by race. Of the 880 patients analyzed, 10% were African American (AA), and 90% were European American (EA). AA more frequently had hypertension (82% vs 67%, p <0.01), diabetes mellitus (45% vs 32%, p = 0.02), chronic kidney disease (28% vs 17%, p = 0.01), and end stage renal disease (18% vs 2%, p <0.001). AA underwent AVR less frequently than EA (39% vs 53%, p = 0.02) and refused intervention more often (33% vs 20%, p = 0.04). When treated, AA and EA had similar 3-year survival (49% [38 to 60] vs 50% [45 to 54], p = 0.31). Identification of the factors associated with treatment refusal would further our ability to counsel patients on the decision to pursue AVR.
authors.affiliation: Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Yeung
authors.forename: Jimmy
authors.initials: J
authors.lastname: Kerrigan
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sodhi
authors.forename: Pei-Hsiu
authors.initials: PH
authors.lastname: Huang
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.forename: Hersh
authors.initials: H
authors.lastname: Maniar
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000208:ethnology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000208:ethnology; D012189:Retrospective Studies; D015996:Survival Rate; D016312:Treatment Refusal / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*