Impact of Economic Status on Utilization and Outcomes of Transcatheter Aortic Valve Implantation and Mitraclip
Section snippets
Methods
We performed a retrospective cohort study after the STROBE checklist and using the Nationwide Readmissions Database (NRD) released by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.9 NRD is a nationally representative database of hospital admissions in United States (US) non-federal hospitals. It includes up to 17 million discharges each year in up to 27 states, accounting for about 57% of all hospitalizations in the US, and providing discharge
Results
Our study included 168,853 patients who underwent TAVI. Of the 168,853 patients identified, 20.6% were in the Q1 income group, 26.3% in the Q2 group, 27.3% in the Q3 group, and 25.8% in the Q4 group. Most patients in all groups were on Medicare. High-income patients were less likely to have DM, hypertension, renal failure, heart failure, and obesity, but more likely to have dyslipidemia and atrial fibrillation (Table 1). The overall utilization of TAVI was 28.8, 34.3, 36.3, and 36.7 per 1,000
Discussion
The principal findings of our study are (1) AVIs including TAVI and MC are utilized less frequently in patients with low income compared with patients in the higher income groups. (2) Clinically significant outcomes including in-hospital mortality, stroke, and 30-day readmissions were generally comparable across income groups except for a slight differential impact of ES on in-hospital mortality for patients undergoing TAVI.
Although socioeconomic disparities in the utilization of traditional
Authors Contribution
Anas M. Saad and Medhat Farwati: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing - original draft; Vardhmaan Jain: Methodology, Writing - original draft; Keerat Rai Ahuja: Visualization, Software, Writing - review & editing; Agam Bansal: Writing - original draft; Mohamed M. Gad: Conceptualization, Validation, Methodology, Writing - review & editing; Toshiaki Isogai: Conceptualization, Methodology, Validation, Supervision, Writing - review &
Disclosures
Authors declare no conflict of interests.
Acknowledgment
This study was made possible by a generous gift from Jennifer and Robert McNeil.
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Social Deprivation and Post-TAVR Outcomes in Ontario, Canada: A Population-Based Study
2023, Journal of the American Heart Association
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study.
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Both authors contributed equally to this manuscript