Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation
Background: Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outco...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
|
| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906724002276 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850220642883862528 |
|---|---|
| author | Jennifer Zhou Shane Nanayakkara Rozanne Johnston Ellen Gardner Nay Min Htun Sonny Palmer Samer Noaman Liam Guiney David M. Kaye Antony S. Walton Dion Stub |
| author_facet | Jennifer Zhou Shane Nanayakkara Rozanne Johnston Ellen Gardner Nay Min Htun Sonny Palmer Samer Noaman Liam Guiney David M. Kaye Antony S. Walton Dion Stub |
| author_sort | Jennifer Zhou |
| collection | DOAJ |
| description | Background: Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS. Methods: Consecutive patients undergoing TAVI for severe AS at three hospitals between August 2008 and February 2023 were prospectively enrolled in a multicentre registry. Patients were stratified into SES quintiles using a census-derived index. Demographic, procedural, and outcomes data were retrospectively analysed. Results: A total of 2,462 patients underwent TAVI during the study period. Lower SES patients were younger than those of higher SES, had more comorbidities, and were less likely to have private health insurance or receive care in private hospitals. Compared to higher SES groups, lower SES patients presented with more advanced disease markers (lower aortic valve area, lower dimensionless index, increased pulmonary hypertension) and were more likely to undergo urgent TAVI, but faced longer wait times for elective TAVI. Despite these pre-procedural differences, mortality and complication rates were similar across SES groups. In multivariable analyses, SES was not an independent predictor of mortality or major adverse cardiovascular events (MACE) at 30 days or 12 months. Conclusions: SES did not independently predict mortality or MACE in patients undergoing TAVI for severe AS. However, disparities in pre-procedural characteristics and access barriers were identified, highlighting the need to address SES-related inequities in healthcare delivery. |
| format | Article |
| id | doaj-art-7ad87f019ca5405e8f38c86de2cce054 |
| institution | OA Journals |
| issn | 2352-9067 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-7ad87f019ca5405e8f38c86de2cce0542025-08-20T02:07:01ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672024-12-015510156110.1016/j.ijcha.2024.101561Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantationJennifer Zhou0Shane Nanayakkara1Rozanne Johnston2Ellen Gardner3Nay Min Htun4Sonny Palmer5Samer Noaman6Liam Guiney7David M. Kaye8Antony S. Walton9Dion Stub10Department of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Cabrini Hospital, Malvern, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Department of Cardiology, Cabrini Hospital, Malvern, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Richmond, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Richmond, AustraliaDepartment of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Cabrini Hospital, Malvern, Australia; Corresponding author at: Heart Centre, Phillip Block, Level 3, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia.Background: Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS. Methods: Consecutive patients undergoing TAVI for severe AS at three hospitals between August 2008 and February 2023 were prospectively enrolled in a multicentre registry. Patients were stratified into SES quintiles using a census-derived index. Demographic, procedural, and outcomes data were retrospectively analysed. Results: A total of 2,462 patients underwent TAVI during the study period. Lower SES patients were younger than those of higher SES, had more comorbidities, and were less likely to have private health insurance or receive care in private hospitals. Compared to higher SES groups, lower SES patients presented with more advanced disease markers (lower aortic valve area, lower dimensionless index, increased pulmonary hypertension) and were more likely to undergo urgent TAVI, but faced longer wait times for elective TAVI. Despite these pre-procedural differences, mortality and complication rates were similar across SES groups. In multivariable analyses, SES was not an independent predictor of mortality or major adverse cardiovascular events (MACE) at 30 days or 12 months. Conclusions: SES did not independently predict mortality or MACE in patients undergoing TAVI for severe AS. However, disparities in pre-procedural characteristics and access barriers were identified, highlighting the need to address SES-related inequities in healthcare delivery.http://www.sciencedirect.com/science/article/pii/S2352906724002276Aortic stenosisTranscatheter aortic valve implantationSocioeconomic statusOutcomesQuality of care |
| spellingShingle | Jennifer Zhou Shane Nanayakkara Rozanne Johnston Ellen Gardner Nay Min Htun Sonny Palmer Samer Noaman Liam Guiney David M. Kaye Antony S. Walton Dion Stub Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation International Journal of Cardiology: Heart & Vasculature Aortic stenosis Transcatheter aortic valve implantation Socioeconomic status Outcomes Quality of care |
| title | Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| title_full | Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| title_fullStr | Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| title_full_unstemmed | Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| title_short | Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| title_sort | association of socioeconomic status with clinical characteristics care quality and outcomes in patients undergoing transcatheter aortic valve implantation |
| topic | Aortic stenosis Transcatheter aortic valve implantation Socioeconomic status Outcomes Quality of care |
| url | http://www.sciencedirect.com/science/article/pii/S2352906724002276 |
| work_keys_str_mv | AT jenniferzhou associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT shanenanayakkara associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT rozannejohnston associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT ellengardner associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT nayminhtun associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT sonnypalmer associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT samernoaman associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT liamguiney associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT davidmkaye associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT antonyswalton associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation AT dionstub associationofsocioeconomicstatuswithclinicalcharacteristicscarequalityandoutcomesinpatientsundergoingtranscatheteraorticvalveimplantation |