Socioeconomic Disparities in Procedural Choice and Outcomes After Aortic Valve Replacement

Authors

Paige E Brlecic
Katie J Hogan
John A Treffalls
Christopher B Sylvester
Joseph S Coselli
Marc R Moon
Todd K Rosengart
Subhasis Chatterjee
Ravi K Ghanta

Publication Date

12-1-2023

Journal

JTCVS Open

DOI

10.1016/j.xjon.2023.10.002

PMID

38204692

PMCID

PMC10775113

PubMedCentral® Posted Date

10-14-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

aortic valve replacement, socioeconomic status, socioeconomic determinants, surgical aortic valve replacement, transcatheter aortic replacement

Abstract

OBJECTIVE: To identify potential socioeconomic disparities in the procedural choice of patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) and in readmission outcomes after SAVR or TAVR.

METHODS: The Nationwide Readmissions Database was queried to identify a total of 243,691 patients who underwent isolated SAVR and TAVR between January 2016 and December 2018. Patients were stratified according to a tiered socioeconomic status (SES) metric comprising patient factors including education, literacy, housing, employment, insurance status, and neighborhood median income. Multivariable analyses were used to assess the effect of SES on procedural choice and risk-adjusted readmission outcomes.

RESULTS: SAVR (41.4%; 100,833 of 243,619) was performed less frequently than TAVR (58.6%; 142,786 of 243,619). Lower SES was more frequent among patients undergoing SAVR (20.2% [20,379 of 100,833] vs 19.4% [27,791 of 142,786]; P < .001). Along with such variables as small hospital size, drug abuse, arrhythmia, and obesity, lower SES was independently associated with SAVR relative to TAVR (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 1.11 to 1.24). After SAVR, but not after TAVR, lower SES was independently associated with increased readmission at 30 days (aOR, 1.19; 95% CI, 1.07-1.32), 90 days (aOR, 1.27; 95% CI, 1.15-1.41), and 1 year (adjusted hazard ratio, 1.19; 95% CI, 1.11 to 1.28; P < .05 for all).

CONCLUSIONS: Our study findings indicate that socioeconomic disparities exist in the procedural choice for patients undergoing AVR. Patients with lower SES had increased odds of undergoing SAVR, as well as increased odds of readmission after SAVR, but not after TAVR, supporting that health inequities exist in the surgical care of socioeconomically disadvantaged patients.