approximately 2.4%. This will undoubtedly further impede patient access and potentially prevent some patients from being offered a therapy with non-inferior and potentially superior outcomes; especially when taking into consideration the outcomes of most importance to the patients.
Valve disease disparities based on race are significant and start even before treatment decisions are being made. Data shows more than 78,000 African Americans are at risk of severe aortic stenosis. An August 2017 American Journal of Cardiology (ACC) study found that the odds of being referred to a cardiothoracic surgeon for treatment of heart valve disease were 54% lower in African American patients compared with whites.
Additionally, data from the STS/ACC TVT Registry™ (the main repository for clinical data related to TAVR) notes that African Americans with heart valve disease refuse TAVR when offered this therapy 33% of this time. Yet, when they were treated, both groups had similar 3-year survival rates. The importance of understanding the reasons behind lower rates of referral and treatment among African Americans cannot be overstated.
There is no question that disparities and access to care issues exist throughout the health care system, and this TAVR coverage decision will not fix that. But, maybe this time CMS can help create an exception to the rule.
Authors:
- Aaron Horne, Jr., MD, MBA, MHS, Association of Black Cardiologists Board Member
- Oluseun Alli, MD, MHA, FACC, Heart Valve Voice US Board Member, Member, Association of Black Cardiologists