Valvular heart disease patients who were black, women, older or used Medicaid were less likely to receive recommended transthoracic echocardiogram (TTE), according to a Massachusetts General Hospital study.
“Black patients with aortic stenosis receive aortic valve replacements (AVRs) less often than white patients, and women have greater mortality following valve surgery,” wrote Varsha K. Tanguturi, MD and colleagues with Massachusetts General Hospital (MGH). “Although little is known about the etiology of these disparities, understanding the mechanisms underlying them is essential to improving health equity.”
In the study published in JACC: Cardiovascular Imaging, Tanguturi and colleagues looked at the data of 130,725 TTEs representing more than 42,000 individual patients taken from an in-house MGH database.
Researchers incorporated administrative data to collect demographic information on patients older than 18 who underwent inpatient or outpatient TTEs between March 2001 through 2016. All included had primary aortic stenosis, aortic insufficiency or mitral regurgitation.
Results were based on if a patient received a TTE within the guideline-recommended timeframe specific to disease type and severity. Tanguturi et al. found:
- Women were 10 percent less likely to receive TTE surveillance compared to men.
- Black patients were 26 percent less likely than their white counterparts to undergo TTEs.
- Those receiving Medicaid were 15 percent less likely than those on Medicare to have guideline-recommended TTEs.
- Increased age correlated with a “significantly” lower likelihood of receiving appropriate TTEs for each decade of life after 60 years, according to authors.
The researchers did not dive into the potential causes of these disparities and noted while they couldn’t account for studies outside of their institution, they are “reassured” main findings “persisted in a cohort cared for largely at MGH,” Tanguturi et al. wrote.
“These results should encourage interventions to improve adherence to consensus guidelines and suggest the need for further investigation into clinical consequences of delayed surveillance,” the authors concluded.