Author + information
- Received July 14, 2019
- Revision received August 28, 2019
- Accepted August 29, 2019
- Published online October 28, 2019.
- Wayne Batchelor, MD, MHSa,b,∗ (, )@_WayneBatchelor,
- Saif Anwaruddin, MDa,c,
- Laura Ross, PA-Ca,d,
- Oluseun Alli, MD, MHAe,
- Michael N. Young, MDa,f,
- Aaron Horne, MD, MBA, MHSg,
- Abby Cestoni, BBAa,
- Frederick Welt, MDa,h and
- Roxana Mehran, MDa,i
- aAmerican College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC
- bInova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia
- cDivision of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania Hospital, Philadelphia, Pennsylvania
- dPark Nicollet Heart and Vascular Center, St. Louis Park, Minnesota
- eNovant Heart and Vascular Institute, Charlotte, North Carolina
- fCardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire
- gHeart and Vascular Specialists of North Hills, HCA Healthcare, North Richland Hills, Texas
- hUniversity of Utah Health, Salt Lake City, Utah
- iThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Wayne Batchelor, Inova Heart & Vascular Institute, 3300 Gallows Road, Suite I-4109, Falls Church, Virginia 22042.
• Underserved minorities represent a low proportion of patients undergoing TAVR and SAVR.
• Differences in disease prevalence and patient, disease, and health system–related factors may all contribute to treatment disparities.
• We present a 4-part intervention aimed at narrowing this treatment gap.
• A collaborative effort from all stakeholders is necessary to achieve equity.
Underserved minorities make up a disproportionately small subset of patients in the United States undergoing transcatheter and surgical aortic valve replacement for aortic stenosis. The reasons for these treatment gaps include differences in disease prevalence and patient, health care system, and disease-related factors. This has major implications not only for minority patients, but also for other groups who face similar challenges in accessing state-of-the-art care for structural heart disease. The authors propose the following key strategies to address these treatment disparities: 1) implementation of measure-based quality improvement programs; 2) effective culturally competent communication and team-based care; 3) improving patient health care access, education, and effective diagnosis; and 4) changing the research paradigm that creates an innovation pipeline for patients. Only a concerted effort from all stakeholders will achieve equitable and broad application of this and other novel structural heart disease treatment modalities in the future.
The views expressed in this paper by the American College of Cardiology's (ACC's) Interventional Section Leadership Council do not necessarily reflect the views of the Journal of the American College of Cardiology nor the ACC.
Dr. Batchelor has received institutional grant/research support from and served as a speaker for Boston Scientific; has served as a consultant for Abbott; and has served on the Speakers Bureau of Boston Scientific, Abbott, and Medtronic. Dr. Anwaruddin has served as a proctor and speaker for Medtronic and Edwards Lifesciences; and has served on the Advisory Board of Medtronic. Dr. Alli has served as a consultant for Edwards Lifesciences, Abbott, and Boston Scientific. Dr. Horne has received honoraria for KOL activities with Edwards Lifesciences, CSI, and Zoll. Dr. Welt has served on the Advisory Board of Medtronic. Dr. Mehran has received institutional grant/research support from Daiichi-Sankyo/Eli Lilly, Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, CSL Behring, Abbott Laboratories, Watermark Research Partners, Novartis Pharmaceuticals, Medtronic, AUM Cardiovascular, and Beth Israel Deaconess Medical Center; has served as a consultant for and/or executive committee of Janssen Pharmaceuticals, Osprey Medical, Watermark Research Partners, Medscape, The Medicines Company, Boston Scientific, Merck, Cardiovascular Systems, Sanofi, Shanghai BraccoSine Pharmaceutical, and AstraZeneca; and has equity in Claret Medical and Elixir Medical Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Hassan Baydoun, MD, served as Guest Associate Editor for this paper.
- Received July 14, 2019.
- Revision received August 28, 2019.
- Accepted August 29, 2019.
- 2019 American College of Cardiology Foundation
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