Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Am J Cardiol. 2021 Mar 1;142:116-123. doi: 10.1016/j.amjcard.2020.11.040. Epub 2020 Dec 5.
Data on the impact of economic status on Transcatheter aortic valve implantation (TAVI) and MitraClip (MC) is lacking. Patients who underwent TAVI and/or MC during 2012 to 2017 were identified in the Nationwide Readmission Database and divided by zip code estimated income quartile into 4 groups (Q1 to Q4). The utilization of TAVI and/or MC was defined as the number of TAVIs and/or MCs over all admissions with an aortic and/or mitral valve disease (AVD and/or MVD) and represented per 1,000 admissions. A total of 168,853 patients underwent TAVI; 20.6% in Q1, 26.3% in Q2, 27.3% in Q3, and 25.8% in Q4, while 15,387 patients underwent MC; 22% in Q1, 26.2% in Q2, 26.3% in Q3, and 25.5% in Q4. The annual utilization of TAVIs and/or MCs increased over the study period and was generally lower with lower income. In 2012, TAVI was performed for 8.2, 8.8, 10.8, and 11.3 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, TAVI was performed for 54.1, 65.1, 68.6, and 71 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2014, MC was performed for 1.6, 2.1, 1.8, and 1.9 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, MC was performed for 5.6, 6.5, 8, and 8 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In-hospital mortality, stroke, and 30-day readmissions were generally comparable across groups. Lower-income patients may be underrepresented among patients undergoing TAVI and MC despite comparable outcomes. Further studies are needed to examine the etiologies behind these disparities and identify targeted strategies for its mitigation.
关于经济状况对经导管主动脉瓣置换术（TAVI）和 MitraClip（MC）的影响的数据尚缺乏。在全国再入院数据库中确定了 2012 年至 2017 年期间接受 TAVI 和/或 MC 的患者，并按邮政编码估计的收入四分位数分为 4 组（Q1 至 Q4）。TAVI 和/或 MC 的利用情况定义为所有患有主动脉瓣和/或二尖瓣疾病（AVD 和/或 MVD）的住院患者中 TAVI 和/或 MC 的数量，并表示为每 1000 例住院患者的数量。共有 168853 例患者接受了 TAVI；Q1 为 20.6%，Q2 为 26.3%，Q3 为 27.3%，Q4 为 25.8%，而 15387 例患者接受了 MC；Q1 为 22%，Q2 为 26.2%，Q3 为 26.3%，Q4 为 25.5%。在研究期间，TAVI 和/或 MC 的年度利用率有所增加，收入越低则越低。2012 年，Q1、Q2、Q3 和 Q4 中，每 1000 例 AVD 入院 TAVI 的分别为 8.2、8.8、10.8 和 11.3 例。2017 年，Q1、Q2、Q3 和 Q4 中，每 1000 例 AVD 入院 TAVI 的分别为 54.1、65.1、68.6 和 71 例。2014 年，Q1、Q2、Q3 和 Q4 中，每 1000 例 MVD 入院 MC 的分别为 1.6、2.1、1.8 和 1.9 例。2017 年，Q1、Q2、Q3 和 Q4 中，每 1000 例 MVD 入院 MC 的分别为 5.6、6.5、8 和 8 例。住院死亡率、中风和 30 天再入院率在各组之间通常相当。尽管结局相当，但低收入患者在接受 TAVI 和 MC 的患者中可能代表性不足。需要进一步研究以检查这些差异背后的病因，并确定减轻这些差异的针对性策略。
