Geographical and socioeconomic disparities in post-transcatheter aortic valve replacement pacemaker placement

Bilal Hussain; Sanchit Duhan; Ahmed Mahmood; Luay Al-Alawi; Mian Muhammad Salman Aslam; Christel Cuevas; Thomas Alexander; Mohammad M Ansari; Fahad Waqar

doi:10.1016/j.carrev.2024.04.010

Geographical and socioeconomic disparities in post-transcatheter aortic valve replacement pacemaker placement

Cardiovasc Revasc Med. 2024 Apr 5:S1553-8389(24)00153-2. doi: 10.1016/j.carrev.2024.04.010. Online ahead of print.

Authors

Bilal Hussain¹, Sanchit Duhan², Ahmed Mahmood³, Luay Al-Alawi³, Mian Muhammad Salman Aslam⁴, Christel Cuevas³, Thomas Alexander³, Mohammad M Ansari⁵, Fahad Waqar⁶

Affiliations

¹ Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America. Electronic address: bilalhussain1094@gmail.com.
² Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, United States of America.
³ Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX, United States of America.
⁴ University of Louisville, Louisville, KY, United States of America.
⁵ Cardiac Cath Lab and Structural Heart Program, Cardiology Department, Texas Tech University Health Sciences Center, Lubbock, TX, United States of America.
⁶ Interventional Cardiology, The Heart Institute - Bon Secours Mercy Health Cincinnati, Cincinnati, OH, United States of America.

PMID: 38594158
DOI: 10.1016/j.carrev.2024.04.010

Abstract

Introduction: Pacemaker (PPM) implantation is indicated for conduction abnormalities which can develop post-transcatheter aortic valve replacement (TAVR). However, whether post-TAVR PPM risk is associated with the geographical location of the hospital and socioeconomic status of the patient is not well established. Our goal was to explore geographical and socioeconomic disparities in post-TAVR PPM implantation.

Methods: A retrospective cohort analysis was conducted using the National Inpatient Sample 2016-2020 with respective ICD-10 codes for TAVR and PPM implantation. A weighted multivariate logistic regression model was used to analyze prognostic outcomes.

Results: The number of patients hospitalized for undergoing TAVR was 296,740, out of which 28,265 patients had PPM implantation (prevalence 9.5 %). Patients' demographics including sex, ethnicity, household income, and insurance were not associated with risk of post-TAVR PPM except age (OR 1.01, CI 1.07-12.5, p < 0.001). Compared to rural hospitals, urban non-teaching hospitals were associated with a higher risk of post-TAVR PPM (OR 2.09, 1.3-3.43, p = 0.003). Compared to New England hospitals (ME, NH, VT, MA, RI, CT), middle Atlantic hospitals (NY, NJ, PA) were associated with highest post-TAVR PPM risk (OR 1.54, CI 1.2-1.98, p < 0.001), followed by Pacific (AK, WA, OR, CA, HI), mountain (ID, MT, WY, NV, UT, CO, AZ, NM) and east north central US.

Conclusion: Patients' demographics including sex, ethnicity, household income, and insurance were not associated with the risk of post-TAVR PPM except for age. Compared to New England hospitals, Middle Atlantic hospitals were associated with the highest post-TAVR PPM risk followed by Pacific, Mountain, and East North Central US. Prospective studies with data on TAVR wait times, expertise of the interventional staff, and post-TAVR management and discharge planning are required to further explore the observed regional distribution of TAVR outcomes.

Keywords: Geographical disparities; New England hospitals; Pacemaker implantation; Socioeconomic disparities; Transcatheter aortic valve replacement.

Publication types

Review