Despite similar prevalence of aortic stenosis, utilization rates of life-saving aortic valve replacement therapy were much lower in women and blacks compared with men and whites, respectively in the US during 2012-2017. 1-year mortality rates for TAVR improved across all subgroups during the study period. Aakriti Gupta, Yun Wang, Torsten Vahl, Ajay Kirtane, Makoto Mori, Isaac George, Susheel Kodali, Martin Leon, Harlan Krumholz NewYork-Presbyterian Hospital and the Columbia University Irving Medical Center, New York, NY, USA Yale-New Haven Hospital, New Haven, CT, USA RESULTS Study population From 100% Medicare Fee-for-Service beneficiaries hospitalized between 2012 and 2017, we included patients with ICD-9 and 10 procedure codes for TAVR and SAVR. Outcomes We report operative rates per 1 000 000 person-years and outcomes including in-hospital mortality, discharge disposition, length-of-stay (LOS) and 1-year mortality rates stratified by sex and race. The availability of both transcatheter and surgical aortic valve replacement (TAVR and SAVR) has revolutionized the care of elderly patients with aortic stenosis, particularly since TAVR was first approved in 2011. It remains unknown, however, whether dissemination of this technology has been equitable. • Rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites, respectively, and the difference was more pronounced for SAVR with rates in women half that in men, and blacks half that in whites (Figure). • In-hospital and 1-year mortality improved for all subgroups through the study period. • Compared with men, women had consistently worse in-hospital mortality but better 1-year mortality rates for TAVR. For SAVR, both in-hospital and 1-year mortality rates were worse in women. • While 1-year mortality rates were comparable between white and black patients undergoing TAVR, black patients undergoing SAVR had consistently worse 1-year mortality rates compared with whites. • Women and blacks were more likely to be discharged to skilled nursing facilities compared with men and whites, respectively. • Length-of-stay for TAVR improved for all subgroups through the study period. CONCLUSION METHODS FIGURE 3 Sex- and Race-based Differences Among Medicare Beneficiaries Undergoing Transcatheter and Surgical Aortic Valve Replacement in the United States, 2012-2017 • Utilization rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites during the study period • While outcomes for SAVR remained stable, in-hospital outcomes and 1-year mortality related to TAVR improved for all subgroups through the study period. • Efforts to minimize treatment disparities should focus on mitigating barriers to both TAVR and SAVR. To examine race- and sex-specific trends in utilization and outcomes for Medicare beneficiaries receiving TAVR and SAVR during 2012-2017 OBJECTIVE BACKGROUND IN-HOSPITAL OUTCOMES DISCLOSURE INFORMATION 16 27 38 53 73 90 82 80 73 67 58 49 22 35 52 70 101 125 156 160 151 142 128 112 2012 2013 2014 2015 2016 2017 Sex-specific AVR hospitalization rates per 100,000 Female_TAVR Female_SAVR Male_TAVR Male_SAVR 8 12 18 25 35 45 21 34 49 67 96 118 50 48 47 44 37 35 126 127 119 111 99 85 2012 2013 2014 2015 2016 2017 Race-specific AVR hospitalization rates per 100,000 Black_TAVR White_TAVR Black_SAVR White_SAVR 13.2 13.9 10.4 12.5 14.1 10.8 10.7 10 8.1 9.1 8.5 8.4 17.6 15.2 12 13.5 12.4 11 20.6 17.3 11.8 13.6 11.1 10.1 2012 2013 2014 2015 2016 2017 Race-specific 1-year mortality (%) SAVR_Black SAVR_White TAVR_Black TAVR_White 11.7 11 9.3 10.2 9.8 10 10.2 9.6 7.5 8.6 8.1 7.6 19.6 16.5 11.5 12.5 10.2 9.3 21.2 17.8 12 14.4 12 10.7 2012 2013 2014 2015 2016 2017 Sex-specific 1-year mortality (%) SAVR_female SAVR_male TAVR_female TAVR_male Dr. Gupta is supported by NIH training grant T32 HL007854. Dr. Gupta reports consulting fees from Edwards Lifesciences and received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook inferior vena cava filter litigation. Dr. Gupta holds equity in a healthcare telecardiology startup, Heartbeat Health, Inc.