Racial Disparities in Adverse Cardiovascular Events After Cardiac Electrophysiology Procedures: A Real-World, Multi-Institutional Retrospective Cohort Study
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Background
Electrophysiology (EP) procedures have revolutionized the management of arrhythmias, improving survival and overall outcomes. However, limited data exists evaluating the long-term outcomes of different EP procedures in underrepresented racial and ethnic groups.
Methods
We utilized data from the TriNetX US collaborative network and included adult participants who underwent EP procedures between 2013-2023 to create two cohorts: non-Hispanic Black and non-Hispanic White participants. Propensity score matching (PSM) was performed using predefined sociodemographic characteristics, medical comorbidities and medications used to ensure balance between groups. Primary outcomes were all-cause mortality at 30-days and 1-year post-EP procedures. Secondary outcomes included new-onset acute myocardial infarction (AMI), ischemic stroke, 3-point major adverse cardiovascular events (MACE), cardiac arrest, ventricular fibrillation (V-fib), ventricular tachycardia (VT), heart failure (HF), and procedure complications including pneumothorax and cardiac tamponade during follow-up.
Results
After PSM, we had improved balance between cohorts with 69,620 matched participants: 50.0% non-Hispanic Black participants with a mean age of 60.7 years; 43.6% females. Compared to non-Hispanic White participants, non-Hispanic Black participants had similar risk of all-cause mortality at 30-days (HR 0.94 95% CI; 0.84,1.06), and 1-year (HR 1.02 95% CI; 0.96,1.08) post-EP procedure after PSM. Moreover, non-Hispanic Black participants had significantly higher risk of developing AMI (HR 1.25 95% CI; 1.10,1.41), 3-point MACE (HR 1.15 95% CI; 1.04,1.27), VT (HR 1.29 95% CI; 1.18,1.42), V-fib (HR 1.28 95% CI; 1.09,1.51) and HF (HR 1.33 95% CI; 1.24,1.42) at 30 days, and these findings remained consistently significant at 1-year follow-up after PSM. No significant differences were noted in all other studied outcomes.
Conclusion
Non-Hispanic Black patients who underwent any EP procedure had a similar risk of 30-day, and 1-year mortality when compared to non-Hispanic White patients. However, non-Hispanic Black participants had higher rates of adverse cardiovascular events in the short and long-term than non-Hispanic White participants post-EP procedure.
Clinical Perspective
What is New?
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This multi-institutional study addresses the question: Are the odds of developing an adverse cardiovascular outcome following an EP procedure the same for a non-Hispanic Black patient when compared to a non-Hispanic White patient?
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Non-Hispanic Black patients who underwent any EP procedure had a similar risk of 30-day, and 1-year mortality when compared to non-Hispanic White patients. However, non-Hispanic Black patients showed a statistically significant higher prevalence of adverse cardiovascular outcomes such as 3-point major adverse cardiovascular events (MACE), acute myocardial infarction, ventricular tachycardia, ventricular fibrillation, and heart failure.
What are the clinical implications?
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This study addresses the racial differences in short– and long-term adverse cardiovascular events following an EP procedure. Better understanding of factors (such as socioeconomic status, health literacy, environmental circumstances etc.) that could potentially limit access to healthcare access among underrepresented racial and ethnic groups (UREG) will better inform policymakers to implement strategies to mitigate these differences.
