Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities
Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI inco...
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| creator | Rogers, Michael P DeSantis, Anthony J Janjua, Haroon M Kulshrestha, Sujay Kuo, Paul C Lozonschi, Lucian |
| description | Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p |
| doi_str_mv | 10.7759/cureus.23643 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9057310</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2671861636</sourcerecordid><originalsourceid>FETCH-LOGICAL-c299t-3b2b01803467d20ca1e4af8906ea19682c915a543a9551ea0a403a41ba1eefe23</originalsourceid><addsrcrecordid>eNpdkc1LHEEQxZtgiGK85RwacvGQNf0x0z19CchGk4AgJOq1qe2tWVtmujf9Ifjfp80aMTlVFfXjUa8eIe84O9G6N59cTVjziZCqk6_IgeBqWAx86PZe9PvkKOc7xhhnWjDN3pB92fe8zeaAbC5rcXHGTONIrxKE7KDcYsFEIazpz5o23sFET2Mq3tEbmO6R_sDtBA5nDIX6QL_4XBLmjI2Pzkd0McS50cs4zzX44jG_Ja9HmDIePdVDcn1-drX8tri4_Pp9eXqxcMKYspArsWJ8YLJTei2YA44djINhCoEbNQhneA99J8E0CwgMOiah46sG4ohCHpLPO91tXc24du3EBJPdJj9DerARvP13E_yt3cR7a1ivJWdN4PhJIMVfFXOxs88OpwkCxpqtUKo9UnRaN_TDf-hdrCk0e43SfFBcSdWojzvKpZhzwvH5GM7sY4h2F6L9E2LD37808Az_jUz-Blrtmns</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2671861636</pqid></control><display><type>article</type><title>Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities</title><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>Rogers, Michael P ; DeSantis, Anthony J ; Janjua, Haroon M ; Kulshrestha, Sujay ; Kuo, Paul C ; Lozonschi, Lucian</creator><creatorcontrib>Rogers, Michael P ; DeSantis, Anthony J ; Janjua, Haroon M ; Kulshrestha, Sujay ; Kuo, Paul C ; Lozonschi, Lucian</creatorcontrib><description>Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p<0.001), sepsis (3.6% vs. 1.9%, p<0.05), and cardiac complications (15.4% vs. 7.5%, p<0.001) when compared to highly distressed SAVR patients. When comparing distressed SAVR and TAVR and low distressed SAVR and TAVR groups, no significant difference was found in postoperative outcomes, except distressed TAVR experienced more cases of UTI. Conclusions Highly distressed TAVR patients had lower incidences of postoperative sepsis, pneumonia, and cardiac complications when compared to the highly distressed SAVR cohort. Patients undergoing TAVR in highly distressed communities had an increased incidence of postoperative urinary tract infection. DCI may be a useful adjunct to current risk scoring systems.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.23643</identifier><identifier>PMID: 35510019</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Cardiac/Thoracic/Vascular Surgery ; Cerebrovascular disease ; Chronic illnesses ; Chronic obstructive pulmonary disease ; Codes ; Comorbidity ; Diabetes ; Economic indicators ; Employment ; Epidemiology/Public Health ; Family income ; Health care policy ; Health Policy ; Heart attacks ; Heart failure ; Hospitals ; Length of stay ; Mortality ; Patients ; Poverty ; Socioeconomic factors ; Software ; Statistical analysis</subject><ispartof>Curēus (Palo Alto, CA), 2022-03, Vol.14 (3), p.e23643-e23643</ispartof><rights>Copyright © 2022, Rogers et al.</rights><rights>Copyright © 2022, Rogers et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2022, Rogers et al. 2022 Rogers et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c299t-3b2b01803467d20ca1e4af8906ea19682c915a543a9551ea0a403a41ba1eefe23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9057310/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9057310/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35510019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rogers, Michael P</creatorcontrib><creatorcontrib>DeSantis, Anthony J</creatorcontrib><creatorcontrib>Janjua, Haroon M</creatorcontrib><creatorcontrib>Kulshrestha, Sujay</creatorcontrib><creatorcontrib>Kuo, Paul C</creatorcontrib><creatorcontrib>Lozonschi, Lucian</creatorcontrib><title>Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p<0.001), sepsis (3.6% vs. 1.9%, p<0.05), and cardiac complications (15.4% vs. 7.5%, p<0.001) when compared to highly distressed SAVR patients. When comparing distressed SAVR and TAVR and low distressed SAVR and TAVR groups, no significant difference was found in postoperative outcomes, except distressed TAVR experienced more cases of UTI. Conclusions Highly distressed TAVR patients had lower incidences of postoperative sepsis, pneumonia, and cardiac complications when compared to the highly distressed SAVR cohort. Patients undergoing TAVR in highly distressed communities had an increased incidence of postoperative urinary tract infection. DCI may be a useful adjunct to current risk scoring systems.</description><subject>Cardiac/Thoracic/Vascular Surgery</subject><subject>Cerebrovascular disease</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Codes</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Economic indicators</subject><subject>Employment</subject><subject>Epidemiology/Public Health</subject><subject>Family income</subject><subject>Health care policy</subject><subject>Health Policy</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Hospitals</subject><subject>Length of stay</subject><subject>Mortality</subject><subject>Patients</subject><subject>Poverty</subject><subject>Socioeconomic factors</subject><subject>Software</subject><subject>Statistical analysis</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkc1LHEEQxZtgiGK85RwacvGQNf0x0z19CchGk4AgJOq1qe2tWVtmujf9Ifjfp80aMTlVFfXjUa8eIe84O9G6N59cTVjziZCqk6_IgeBqWAx86PZe9PvkKOc7xhhnWjDN3pB92fe8zeaAbC5rcXHGTONIrxKE7KDcYsFEIazpz5o23sFET2Mq3tEbmO6R_sDtBA5nDIX6QL_4XBLmjI2Pzkd0McS50cs4zzX44jG_Ja9HmDIePdVDcn1-drX8tri4_Pp9eXqxcMKYspArsWJ8YLJTei2YA44djINhCoEbNQhneA99J8E0CwgMOiah46sG4ohCHpLPO91tXc24du3EBJPdJj9DerARvP13E_yt3cR7a1ivJWdN4PhJIMVfFXOxs88OpwkCxpqtUKo9UnRaN_TDf-hdrCk0e43SfFBcSdWojzvKpZhzwvH5GM7sY4h2F6L9E2LD37808Az_jUz-Blrtmns</recordid><startdate>20220330</startdate><enddate>20220330</enddate><creator>Rogers, Michael P</creator><creator>DeSantis, Anthony J</creator><creator>Janjua, Haroon M</creator><creator>Kulshrestha, Sujay</creator><creator>Kuo, Paul C</creator><creator>Lozonschi, Lucian</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220330</creationdate><title>Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities</title><author>Rogers, Michael P ; DeSantis, Anthony J ; Janjua, Haroon M ; Kulshrestha, Sujay ; Kuo, Paul C ; Lozonschi, Lucian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c299t-3b2b01803467d20ca1e4af8906ea19682c915a543a9551ea0a403a41ba1eefe23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cardiac/Thoracic/Vascular Surgery</topic><topic>Cerebrovascular disease</topic><topic>Chronic illnesses</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Codes</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Economic indicators</topic><topic>Employment</topic><topic>Epidemiology/Public Health</topic><topic>Family income</topic><topic>Health care policy</topic><topic>Health Policy</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Hospitals</topic><topic>Length of stay</topic><topic>Mortality</topic><topic>Patients</topic><topic>Poverty</topic><topic>Socioeconomic factors</topic><topic>Software</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rogers, Michael P</creatorcontrib><creatorcontrib>DeSantis, Anthony J</creatorcontrib><creatorcontrib>Janjua, Haroon M</creatorcontrib><creatorcontrib>Kulshrestha, Sujay</creatorcontrib><creatorcontrib>Kuo, Paul C</creatorcontrib><creatorcontrib>Lozonschi, Lucian</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rogers, Michael P</au><au>DeSantis, Anthony J</au><au>Janjua, Haroon M</au><au>Kulshrestha, Sujay</au><au>Kuo, Paul C</au><au>Lozonschi, Lucian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2022-03-30</date><risdate>2022</risdate><volume>14</volume><issue>3</issue><spage>e23643</spage><epage>e23643</epage><pages>e23643-e23643</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p<0.001), sepsis (3.6% vs. 1.9%, p<0.05), and cardiac complications (15.4% vs. 7.5%, p<0.001) when compared to highly distressed SAVR patients. When comparing distressed SAVR and TAVR and low distressed SAVR and TAVR groups, no significant difference was found in postoperative outcomes, except distressed TAVR experienced more cases of UTI. Conclusions Highly distressed TAVR patients had lower incidences of postoperative sepsis, pneumonia, and cardiac complications when compared to the highly distressed SAVR cohort. Patients undergoing TAVR in highly distressed communities had an increased incidence of postoperative urinary tract infection. DCI may be a useful adjunct to current risk scoring systems.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>35510019</pmid><doi>10.7759/cureus.23643</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiac/Thoracic/Vascular Surgery Cerebrovascular disease Chronic illnesses Chronic obstructive pulmonary disease Codes Comorbidity Diabetes Economic indicators Employment Epidemiology/Public Health Family income Health care policy Health Policy Heart attacks Heart failure Hospitals Length of stay Mortality Patients Poverty Socioeconomic factors Software Statistical analysis |
| title | Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities |
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