In 2017, the first patient walked out of the doors of Spartanburg Medical Center with a new heart valve — but for the first time, they walked out just 48 hours after the procedure without having to undergo surgery. SMC’s state-leading health program introduced TAVR as a non-surgical way to combat aortic stenosis.
More than 300 patients have received this potentially life-saving treatment in the past four years at Spartanburg Medical Center; however, access to that treatment has not reached all areas of our community. Over the past two years, a rigorous population analytic study of TAVR patients and community-members has revealed that black patients are not represented in the TAVR patient population in accordance with the community demographics, despite having equal or higher levels of risk for needing the procedure.
Aortic stenosis is one of the most common and serious heart valve disease problems, affecting up to 2.5 million people over the age of 75 in the United States. Traditionally, open heart surgery has been used to replace the diseased aortic valve and restore normal blood flow, but a new procedure called TAVR, first approved by the FDA in 2011, has recently become a more common treatment method for aortic stenosis. Compared with open heart surgery — a complex procedure in which the chest must be fully opened — TAVR is associated with shorter recovery times, lower complication risks, and is less painful for patients, who can often return to normal activities within a few days. In 2019, TAVR was approved for use in low risk patients, extending its applicability as a viable treatment method for all patients with aortic stenosis.
South Carolina sits right in the heart belt of our nation, with some of the highest incidences of heart problems. In 2017, cardiovascular disease remained the leading cause of death in South Carolina, causing 10,412 deaths, 21.1 percent of all deaths in that year. Around 12.4%, or ~2.5 million people ages 75+ in the United States, have either mild, moderate, or severe aortic stenosis. Without treatment for severe aortic stenosis, survival rates are low at 50% at 2 years after symptom onset, and 20% at 5 years.
A study was conducted using de-identified patient data on the more than 300 TAVR patients and on information collected from community-members in populations that are at risk of developing aortic stenosis through a survey distributed to more than 200 community members at barber shops, churches, community centers, and schools.
Demographic differences between TAVR patient population and Spartanburg, Laurens, Union, and Cherokee counties’ population
Data collected from the local health record system show that 9.7 percent of the patients who have been treated by TAVR in Spartanburg, Laurens, Union, and Cherokee counties (those whose nearest TAVR option is SMC) have been black. 89.7 percent have been white. This is in stark contrast to the racial demographics of 73.5 percent white and 22.1 percent black of those four counties.
Results
The results of the study indicate that the black population on average does not have the same distribution of “advantages” that the TAVR patient population has — access to insurance, primary care physicians, average household value of $154,000 — which could be a factor for why they are not represented equitably. However, the data does indicate a similar outlook in the disadvantages between the TAVR patient population and the black population— risk factors such as high cholesterol and high blood pressure.
Other Significant Findings
Of those who had a heart murmur (a significant indicator of a potentially fatal heart condition treatable by TAVR or other similar procedures), 50% of surveyed members did not receive any sort of further action (further tests ordered such as echocardiograms, specialist referral, PCP followup).
Of those without health insurance, all listed the reason for not having health insurance was due to not being able to afford it.
Of those who had a PCP, 11.8% percent of surveyed members said their PCP does not refer to specialists appropriately with regularity (answered “No” or “sometimes” as opposed to “most of the time” or “yes).
13.6% percent of surveyed members said they do not have trust in the upstate healthcare system (a score of less than 5 on a scale of 1-10). Of those, 66.7% percent said it was because of personal experiences with the healthcare system.
21.5% percent of surveyed members said they had experienced some form of unfair treatment by a healthcare worker: “I went to the emergency room 2 months ago. My body was aching and I had a bad head-ache. I don't feel like they did everything in their power to figure out what was wrong with me.”
15.2% percent of surveyed members said they or someone they knew had felt discriminated against by a healthcare worker because of race: “They rarely feel blacks feel pain and at times I am made to feel that I am not in pain when I am."
Methods
Patient data was collected from the local health record system with permission granted by Spartanburg Medical Center providers. Data was de-identified. A healthcare accessibility survey was distributed to 200 people and garnered 87 responses, representing a response rate of 43.5 percent. The survey was conducted from August 10 to October 10. The data was not adjusted for possible non-response bias. Statistical tests were conducted using the programming language R to determine statistical significance of data.