Zhou Jennifer, Nanayakkara Shane, Johnston Rozanne, Gardner Ellen, Htun Nay Min, Palmer Sonny, Noaman Samer, Guiney Liam, Kaye David M, Walton Antony S, Stub Dion
Department of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Int J Cardiol Heart Vasc. 2024 Nov 21;55:101561. doi: 10.1016/j.ijcha.2024.101561. eCollection 2024 Dec.
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.
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.
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.
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.
在许多情况下，社会经济地位（SES）是医疗保健结果的重要决定因素，但很少有研究评估SES对主动脉瓣狭窄（AS）患者的影响。我们试图探讨SES与接受经导管主动脉瓣植入术（TAVI）治疗严重AS患者的临床特征、护理质量和结局之间的关联。
2008年8月至2023年2月期间，在三家医院接受TAVI治疗严重AS的连续患者被前瞻性纳入一个多中心登记处。使用基于人口普查得出的指数将患者分为SES五分位数。对人口统计学、手术和结局数据进行回顾性分析。
在研究期间，共有2462例患者接受了TAVI。SES较低的患者比SES较高的患者更年轻，合并症更多，拥有私人医疗保险或在私立医院接受治疗的可能性更小。与SES较高的组相比，SES较低的患者表现出更晚期的疾病标志物（主动脉瓣面积更小、无因次指数更低、肺动脉高压增加），更有可能接受紧急TAVI，但择期TAVI的等待时间更长。尽管存在这些术前差异，但SES组之间的死亡率和并发症发生率相似。在多变量分析中，SES不是30天或12个月时死亡率或主要不良心血管事件（MACE）的独立预测因素。
SES不能独立预测接受TAVI治疗严重AS患者的死亡率或MACE。然而，术前特征和获取障碍方面的差异被识别出来，凸显了解决医疗服务中与SES相关不平等问题的必要性。
