Socioeconomic factors and long-term mortality risk after transcatheter aortic valve implantation

Abstract

Abstract Background There is scarce knowledge about the association between socioeconomic factors and outcome in patients undergoing transaortic valve implantation (TAVI). Therefore, the aim was to explore the association between marital status, educational level and long-term mortality risk in patients who underwent TAVI. Methods The SWEDEHEART registry was used to identify all patients who underwent TAVI due to aortic stenosis in Sweden from 2014 to 2020. Socioeconomic factors and comorbidities were collected from mandatory national registries. Cox regression models adjusted for baseline comorbidities, age, sex, smoking, education and marital status were used to estimate the mortality risk. Median follow-up were 1.9 years (interquartile range 0.8-3.2 years). Results In total, 6280 patients were included (47.1% women) with a mean age of 81.5 years (SD 7.1). Common baseline characteristics were hypertension (84.4%), heart failure (45.9%) and history of smoking (51.0%). During follow-up, 1584 (25.6%) of the patients died, of these, 860 (54.3%) deaths were related to cardiovascular causes. Lowest educational level (<10 years) was associated with a higher risk of mortality compared to patients with the highest education level (>12 years) (adjusted hazard ratio (aHR) 1.17 (95% Confidence interval (CI 1.01–1.35). Never being married/cohabiting, compared to married/cohabiting was not associated with an increased risk of mortality, (aHR 1.21 (95% CI 0.98-1.50)). The risk was increased for men (aHR of 1.45 (95% CI 1.12–1.88)), but not for women (aHR 0.81 (95% CI 0.55–1.19)). Conclusions Disadvantage in socioeconomic status was associated with an increased risk of mortality after TAVI. These findings emphasize the importance to develop strategies to increase health literacy and social support after TAVI, to patients with unfavorable socioeconomic factors.