Impact of social deprivation on outcome following transcatheter aortic valve implantation (TAVI)

Abstract

ObjectivesWe sought to evaluate whether socioeconomic status influences outcome after first-time transcatheter aortic valve implantation (TAVI).MethodThis is a single-centre study carried out in Swansea, South West Wales, UK between 5 November 2009 and 10 June 2018. Data included age, gender, domiciliary postal code, comorbidities, complications post-TAVI, length of stay, follow-up time and survival status. The Welsh Index of Multiple Deprivation, 2014 was used to stratify cases by level of social deprivation according to domiciliary postal codes.ResultsStudy population was 387 patients of whom 213 (54.8%) were men with mean age ±SD of 82.8±8.3 years. Patients, who were less deprived (296 (76.4%)), were more likely to be older (83.5±7.9 vs 80.4±9.3, p<0.05) and to be married (83.2% vs 69.7%, p<0.05). Conversely, ‘more deprived’ patients (91 (23.6%)) were more likely to have a longer stay in hospital as compared with patients in the ‘less deprived group’ (29.6±32.7 days vs 21.3±21.1 days, p<0.05). However, 30-day, 1-year and 3-year survival/mortality rates were similar across all socioeconomic levels.ConclusionsThis is the first study in which social deprivation has been investigated as a risk factor for mortality in a high-risk group of patients with severe aortic stenosis undergoing TAVI. Residing in a ‘more deprived’ area in South West Wales is not associated with adverse outcome following TAVI but patients who are ‘more deprived’ tend to stay longer in hospital compared with patients who are ‘less deprived’.

The role of neighborhood disadvantage in predicting mortality in patients after transcatheter aortic valve replacement

“…The authors found that patients living in more-deprived areas were more likely to have longer hospital stays compared to patients from less-deprived areas but that there was no difference in mortality at 30-days, 1-year, or 3-years. 24 Contrary to these findings, our current study demonstrates that neighborhood disadvantage is able to predict mortality in patients after TAVR. One potential reason for our findings being at odds with those of Mohee et al could be the difference in sample size.…”

“…A study published by Mohee et al in 2019 evaluated the role of social deprivation based on postal codes in 387 patients undergoing TAVR in South West Wales. The authors found that patients living in more‐deprived areas were more likely to have longer hospital stays compared to patients from less‐deprived areas but that there was no difference in mortality at 30‐days, 1‐year, or 3‐years 24 . Contrary to these findings, our current study demonstrates that neighborhood disadvantage is able to predict mortality in patients after TAVR.…”

The impact of education as a marker of socio-economic status on survival of patients after transcatheter aortic valve implantation

“…The interaction between outcomes following TAVI and SES has not been studied in detail thus far. Mohee et al [ 24 ] studied the association of low SES with outcomes following TAVI in 387 patients. In contrast to our study, they evaluated SES mainly by income and concluded that social deprivation was not associated with adverse outcomes.…”

“…Although we had patients referred from different locations and almost all districts of the country, our cohort is rather small and can potentially give biased results. On the other hand, data on outcomes after TAVI based on SES or education are rather scarce [ 24 ], and therefore we believe that our current data carry considerable weight.…”

Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study

“… 7 , 8 , 9 However, there is a paucity of data on the impact of these disparities on postprocedure outcomes; the available literature is both limited in scope and is not reflective of contemporary TAVR practice. 9 , 10 …”