Contrasting impacts of social deprivation and ethnicity on novel vs. established cardiovascular procedures: A population-level study of TAVR and SAVR
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Background
Social deprivation markers are associated with worse clinical outcomes after cardiac revascularization procedures. However, the association between social deprivation and cardiac valvular procedural outcomes is less established. We sought to distinguish the relationship between social deprivation and outcomes in the management of severe aortic stenosis, specifically transcatheter aortic valve replacement (TAVR) versus conventional surgical aortic valve replacement (SAVR).
Methods
Demographics, patient comorbidities, procedural details, and outcomes for adults undergoing TAVR and SAVR between April 2017 and March 2022 were obtained from clinical and administrative databases and linked to neighbourhood-level measures of social deprivation using the Ontario Marginalization Index (ON-MARG) in Ontario, Canada. The three dimensions of social deprivation assessed were (1) material deprivation, (2) residential instability and (3) ethnic concentration. Our outcomes were 30-day mortality, 30-day readmission, 1-year mortality and 1-year readmission. Separate Cox proportional hazard models for post-procedural mortality and cause-specific hazard models for post-procedural re-admission were used to determine the association between social deprivation and post-procedural outcomes after TAVR versus SAVR.
Results
We identified a total of 6,218 TAVR procedures and 3,342 isolated SAVR procedures within our study period after exclusion criteria were applied. After multivariable adjustment, we found that TAVR was associated with lower 30-day mortality (HR 0.58; 95% CI [0.37, 0.92]; p = 0.02), lower 30-day readmission rates (HR 0.75; 95% CI [0.63, 0.89]; p-value = 0.001) and a higher 1-year readmission rate (HR 1.14; 95% CI [1.02, 1.27]; p-value = 0.01) when compared to SAVR. When the three ON-MARG domains by treatment interactions were included in the analysis, the associations between TAVR and SAVR and these outcomes were not modified by the degree of neighbourhood social deprivation.
Conclusion
TAVR is associated with lower 30-day mortality and 30-day re-admission rates and higher 1-year re-admission compared to SAVR. These associations were not modified by social deprivation, including ethnic concentration, material deprivation and residential instability.
