Temporal Changes in Racial and Ethnic Disparities in the Utilization of Left Atrial Appendage Occlusion in the United States.

Racial and ethnic disparities in the access to left atrial appendage occlusion (LAAO) have been previously described. However, it remains unclear if there have been any changes in these disparities over the years and if the disparities include other racial and ethnic groups not previously studied. We aimed to determine the temporal evolution of the racial and ethnic disparities in the utilization of LAAO from 2016 to 2019. We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2019. International Classification of Diseases, 10th edition codes were used to identify all adult admissions with atrial fibrillation (AF) and those who underwent LAAO. The sample was divided into Asian American and Pacific Islander, Black, Hispanic, White, and other races/ethnicities. Our primary outcome was the utilization of LAAO in patients admitted with a diagnosis of AF. The Cochran-Armitage test was conducted to evaluate the yearly trend in LAAO utilization stratified by race/ethnicity. Multivariable regression analysis was conducted to assess the association of race/ethnicity with multiple end points. A total of 59,415 patients underwent LAAO. The highest yearly increase in LAAO utilization was seen in White patients (trend: 0.16%, p <0.001). Furthermore, compared with White patients, the yearly increase in LAAO utilization was lower in all other racial/ethnic groups. Black patients had the lowest odds of who underwent LAAO (odds ratio = 0.45, 95% confidence interval 0.40 to 0.50, p <0.001). In conclusion, significant gaps exist in the utilization of LAAO between racial and ethnic groups, and they appear to continue worsening from 2016 to 2019.

Trends and In-Hospital Outcomes of Patients With Baseline Right Bundle Branch Block Who Underwent Transcatheter Aortic Valve Implantation.

This study aimed to explore contemporary in-hospital outcomes and trends of transcatheter aortic valve implantation (TAVI) outcomes in patients with baseline right bundle branch block (RBBB) using data collected from a nationwide sample. Using the National Inpatient Sample, we identified patients hospitalized for an index TAVI procedure from 2016 to 2019. Primary outcomes included in-hospital all-cause mortality, complete heart block, and permanent pacemaker (PPM) implantation. A total of 199,895 hospitalizations for TAVI were identified. RBBB was present in 10,495 cases (5.3%). Patients with RBBB were older (median age 81 vs 80 years, p <0.001) and less likely to be female (35% vs 47.4%, p <0.001). After adjusting for differences in baseline characteristics and elective versus nonelective admission, patients with RBBB had a higher incidence of complete heart block (adjusted odds ratio [aOR] 4.77, confidence interval [CI] 4.55 to 5.01, p <0.001) and PPM implantation (aOR 4.15, CI 3.95 to 4.35, p <0.001) and no difference in-hospital mortality rate (aOR 0.85, CI 0.69 to 1.05, p = 0.137). Between 2016 and 2019, there was a 3.5% and 2.9% decrease in in-hospital PPM implantation in patients with and without RBBB, respectively. In conclusion, from 2016 to 2019, the rate of in-hospital PPM implantation decreased during index TAVI hospitalization in both patients with and without RBBB. However, in those with baseline RBBB, complete heart block complication rates requiring PPM implantation remain relatively high. Further research and advances are needed to continue to reduce complication rates and the need for PPM implantation.

Impact of left bundle branch block in Takotsubo Syndrome.

Background: Left bundle branch block (LBBB) causes left ventricular dyssynchrony, and its presence with concomitant left ventricular dysfunction has been proven to play a synergistic role, worsening ventricular function. Our study seeks to further explore the association between LBBB and various in-hospital outcomes in patients with takotsubo syndrome (TTS). Methods: The national inpatient sample was queried from 2016 to 2019 to identify all admissions with a primary diagnosis of TTS. International classification of diseases, tenth revision codes were used to divide patients based on the presence or absence of LBBB. Multivariate regression analysis was performed to assess the effect of LBBB among all the pre-specified outcomes. Results: A total of 26,615 admissions were included in the analysis. Admissions with LBBB were more likely to be older (72.2 vs. 66.2 years) and have a higher burden of comorbidities. The presence of a LBBB was associated with ventricular arrhythmias (OR = 1.97, 95% CI 1.08-3.61, p = 0.028) but not with sudden cardiac arrest (SCA), acute heart failure, cardiogenic shock, and all-cause intra-hospital mortality. Conclusions: Intraventricular dyssynchrony appears to play a significant role in ventricular arrhythmogenesis and SCA, as several trials have demonstrated that cardiac resynchronization therapy alone without defibrillator function reduces the rate of ventricular arrhythmias and SCA in patients with heart failure with systolic dysfunction and a widened QRS complex. The most likely mechanism of arrhythmia development in TTS is related to the elevated plasma levels of catecholamines and their proarrhythmic effects in the ventricular myocardium.

Prevalence of conduction abnormalities in a systolic heart failure population by race, ethnicity, and gender.

BACKGROUND: There is paucity of data regarding conduction abnormalities in the Hispanic population with systolic heart failure (HF). We aimed to evaluate the prevalence of electrocardiogram (ECG) abnormalities in a systolic HF population, with attention to the Hispanic population. METHODS: A cross sectional study of 926 patients enrolled in a systolic HF disease management program. ECGS were obtained in patients with an ejection fraction (EF) ≤ 40% by echocardiography at enrollment. Univariate and multivariate analysis adjusted by ethnicities was performed. RESULTS: White patients exhibited higher prevalence of atrial fibrillation (14.7%) than black patients (8.0%, P = 0.01) whereas Hispanics presented higher prevalence of paced rhythm (14.3% in Hispanics vs. 6.5% in whites and 5.2% in blacks, P<0.01 for both comparisons), higher prevalence of left bundle branch block (LBBB, 14.5% in Hispanics vs. 8.8% in whites and 5.8% in blacks, P = 0.002) and increased frequency of abnormal QT intervals (76.7% in Hispanics) than whites (59.6%) and blacks (69%) patients (P< 0.01 for both comparisons). A QRS interval greater than 120 ms was less prevalent among blacks (15.8% vs. 26.0% in whites and 25.3% in Hispanics, P = 0.01 for both comparisons). Univariate and multivariate analysis disclosed no influence of other characteristics (age, sex, coronary artery disease, hypertension, ejection fraction, medications) in the ECG findings. CONCLUSIONS: Hispanics with Systolic HF presented with increased prevalence of paced rhythm, LBBB, and abnormal QT intervals. Attention should be addressed to these ECG variations to recommend additional guidance for therapeutic interventions and provide important prognostic information.

Prevalence of electrocardiographic abnormalities in a systolic heart failure disease management population by race, ethnicity, and sex.

The prevalence of electrocardiographic (ECG) abnormalities in systolic heart failure patients have predominantly been described in white patients, with relatively little known about their prevalence in black and Hispanic populations. The purpose of this study is to compare the prevalence of ECG abnormalities by race, ethnicity, and sex. The authors conducted an observational prospective study that included 926 patients from 2 hospital facilities. A systolic heart failure disease management program implemented in both sites enrolled patients with an ejection fraction < or =40% by echocardiography. Black patients had less evidence of myocardial infarction than whites and Hispanics. Black patients had more evidence of left ventricular hypertrophy than Hispanics and whites. Hispanics evidenced more ischemic changes than blacks and whites. Among black patients, left ventricular hypertrophy was more prevalent in women. ECG abnormalities vary across race, ethnicity, and sex. These variations may have implications for further diagnostic testing and potential treatment regimens.