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J Am Coll Cardiol. 2019 Nov 5;74(18):2313-2321. doi: 10.1016/j.jacc.2019.08.1035.

Aortic Valve Stenosis Treatment Disparities in the Underserved: JACC Council Perspectives.

Author information

1
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia. Electronic address: Wayne.Batchelor@inova.org.
2
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania Hospital, Philadelphia, Pennsylvania.
3
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; Park Nicollet Heart and Vascular Center, St. Louis Park, Minnesota.
4
Novant Heart and Vascular Institute, Charlotte, North Carolina.
5
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire.
6
Heart and Vascular Specialists of North Hills, HCA Healthcare, North Richland Hills, Texas.
7
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC.
8
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; University of Utah Health, Salt Lake City, Utah.
9
American College of Cardiology Interventional Cardiology Sectional Leadership Committee, Washington, DC; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.

Abstract

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.

KEYWORDS:

TAVR; aortic stenosis; health care disparities; outcomes; prevalence

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