Impact of social deprivation on outcome following transcatheter aortic valve implantation (TAVI)

Kevin Mohee; Majd B Protty; Tony Whiffen; Alexander Chase; Dave Smith

doi:10.1136/openhrt-2019-001089

Impact of social deprivation on outcome following transcatheter aortic valve implantation (TAVI)

Open Heart. 2019 Dec 5;6(2):e001089. doi: 10.1136/openhrt-2019-001089. eCollection 2019.

Authors

Kevin Mohee¹, Majd B Protty², Tony Whiffen³, Alexander Chase¹, Dave Smith¹

Affiliations

¹ Department of Cardiology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
² Systems Immunity University Research Institute, Cardiff University, Cardiff, South Glamorgan, UK.
³ Welsh Government, Cardiff, Administrative Data Research Unit, Cardiff, UK.

Abstract

Objectives: We sought to evaluate whether socioeconomic status influences outcome after first-time transcatheter aortic valve implantation (TAVI).

Method: This is a single-centre study carried out in Swansea, South West Wales, UK between 5 November 2009 and 10 June 2018. Data included age, gender, domiciliary postal code, comorbidities, complications post-TAVI, length of stay, follow-up time and survival status. The Welsh Index of Multiple Deprivation, 2014 was used to stratify cases by level of social deprivation according to domiciliary postal codes.

Results: Study population was 387 patients of whom 213 (54.8%) were men with mean age ±SD of 82.8±8.3 years. Patients, who were less deprived (296 (76.4%)), were more likely to be older (83.5±7.9 vs 80.4±9.3, p<0.05) and to be married (83.2% vs 69.7%, p<0.05). Conversely, 'more deprived' patients (91 (23.6%)) were more likely to have a longer stay in hospital as compared with patients in the 'less deprived group' (29.6±32.7 days vs 21.3±21.1 days, p<0.05). However, 30-day, 1-year and 3-year survival/mortality rates were similar across all socioeconomic levels.

Conclusions: This is the first study in which social deprivation has been investigated as a risk factor for mortality in a high-risk group of patients with severe aortic stenosis undergoing TAVI. Residing in a 'more deprived' area in South West Wales is not associated with adverse outcome following TAVI but patients who are 'more deprived' tend to stay longer in hospital compared with patients who are 'less deprived'.

Keywords: TAVI; length of stay; mortality; social deprivation.