Racial and Ethnic Differences in Left Atrial Appendage Occlusion Wait Time, Complications, and Periprocedural Management
| Autor: | Martin G. Keane, Edmond M. Cronin, Jacqueline Sherrer, Rebecca Garber, Chethan Gangireddy, Matthew Bocchese, Sabrina Islam, Joshua M. Cooper, Brian P. O'Neill, George A. Yesenosky, Pravin Patil, Anuj Basil, Abdullah Haddad, Isaac R. Whitman |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Waiting Lists medicine.medical_treatment Ethnic group 030204 cardiovascular system & hematology Left atrial appendage occlusion Perioperative Care End stage renal disease 03 medical and health sciences 0302 clinical medicine Postoperative Complications Internal medicine Atrial Fibrillation Ethnicity Humans Medicine Atrial Appendage 030212 general & internal medicine Cardiac Surgical Procedures Stroke Oral anticoagulation Aged Retrospective Studies Aged 80 and over business.industry Racial Groups Atrial fibrillation General Medicine Middle Aged Bleed medicine.disease Wait time Median time Heart failure Female Cardiology and Cardiovascular Medicine business |
| DOI: | 10.22541/au.159826694.41816043 |
| Popis: | PURPOSE Non-white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. METHODS We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post-procedure oral anticoagulation (OAC) use in whites versus non-whites. RESULTS Among 109 patients undergoing LAAO (45% white), whites had lower CHA2 DS2 VASc scores, on average, than non-whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non-whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non-whites 5%, p = .33). After adjusting for CHA2 DS2 VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9-6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2 DS2 VASc score and GI bleed severity, whites had a nearly five-fold odds of being discharged on OAC (OR 4.6, 95% CI [1-21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [-.04-0.11], p = .38). CONCLUSION Despite an increased prevalence of comorbidities amongst non-whites, wait time for LAAO and procedural complications were similar in whites versus non-whites. Among those with prior GI bleed, whites were nearly five-fold more likely to be discharged on OAC than non-whites, independent of income. |
| Databáze: | OpenAIRE |
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