Abstract 15935: Socioeconomic Disparities in Urgent versus Elective Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample

Objective: Cardiac interventions performed urgently are known to be associated with poor outcomes compared to electively performed procedures. Transcatheter edge-to-edge mitral valve repair (TMVr) has developed as a reasonable alternative to mitral valve surgery in certain patient populations. We aimed to leverage a national database to identify predictors of urgent versus elective TMVr, as well as the association between urgency and outcomes. Methods: The National Inpatient Sample (NIS) was queried to identify weighted hospital discharge records of patients who underwent TMVr from 2016 - 2017. Hospitalizations are identified within the database as elective versus non-elective. Univariate and multivariable analyses were performed to identify patient characteristics associated with urgent procedures. In-hospital outcomes were assessed. Results: There were 10,195 cases of TMVr in this cohort, 24.2% of which were performed urgently. In multivariable analysis, Hispanic race, Medicaid insurance, and low income were associated with increased likelihood of urgent hospital admission and TMVr. Additionally, small hospital size and Northeast region were associated with increased likelihood of urgent admission and procedure. Older patients were more likely to undergo elective procedures (Table 1). Urgent TMVr was associated with increased mortality (4.5% vs. 1.6%, p < .001), prolonged length of stay (6.0 vs. 2.0, p < .001), and increased cost ($267,292 vs. $167,889, p < .001). Conclusion: Socioeconomic disparities exist in the utilization of TMVr as an urgent versus elective procedure, suggesting differences in access to surveillance and preventive care. Urgent TMVr is associated with increased morbidity and mortality, prolonged length of stay, and increased hospital costs. Priority should be placed on mitigating such disparities to improve outcomes.