Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York

Abstract

Background. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods. The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results. Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions. While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.

Predictors and risk-adjusted outcomes of new-onset postoperative atrial fibrillation in repeat surgical and valve-in-valve transcatheter aortic valve replacement

“…Based on a study by Taylor et al, black patients who underwent a mitral valve replacement or an AVR were also significantly associated with an increased risk of procedural complications such as prolonged ventilation, longer postoperative stay, and reoperation for bleeding; these patients were generally in poorer health compared to white patients, with higher New York Heart Association class and pulmonary artery pressures and lower ejection fractions [33] . This disparity in health outcomes for black patients is likely due to limited access to care despite these patients residing near hospital centers that perform TAVR, as indicated by Nathan et al and Bilfinger et al [34,35] . Elixhauser score, reflecting comorbidity burden in patients undergoing r-AVR procedures was also shown to a predictor of MM and was similarly shown in a study by Nagaraja et al examining 40,604 TAVR patients [36] .…”

Impact of Community Socioeconomic Distress on Survival Following Heart Transplantation

“…15 Prior work has demonstrated the independent association of DCI with higher posttransplant mortality and increased acuity of illness at listing for transplantation, among other inferior postoperative outcomes. [16][17][18][19][20] In a study of children with end-stage heart disease, Wright et al 21 noted patients from distressed communities to have a lower likelihood of listing for transplantation. Nonetheless, the contemporary association of neighborhood distress and post-heart transplant outcomes has not been fully characterized at a large scale.…”

“…The Distressed Communities Index (DCI), a composite of several neighborhood factors including unemployment, poverty level, median income, and housing vacancies, has been used to capture the local level of community prosperity 15 . Prior work has demonstrated the independent association of DCI with higher posttransplant mortality and increased acuity of illness at listing for transplantation, among other inferior postoperative outcomes 16–20 . In a study of children with end-stage heart disease, Wright et al 21 noted patients from distressed communities to have a lower likelihood of listing for transplantation.…”