Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York
Background. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We a...
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Wiley
2021-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2021/8837644 |
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| author | Thomas Bilfinger Allison Nemesure Robert Pyo Jonathan Weinstein Giridhar Korlipara Daniel Montellese Shamim Khan Neal Patel Henry Tannous Ting-Yu Wang Ely Gracia Susan Callahan Puja B. Parikh |
| author_facet | Thomas Bilfinger Allison Nemesure Robert Pyo Jonathan Weinstein Giridhar Korlipara Daniel Montellese Shamim Khan Neal Patel Henry Tannous Ting-Yu Wang Ely Gracia Susan Callahan Puja B. Parikh |
| author_sort | Thomas Bilfinger |
| collection | DOAJ |
| description | Background. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods. The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results. Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions. While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator. |
| format | Article |
| id | doaj-art-976e8e0ab1324b1aa0389cf4bb12a921 |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-976e8e0ab1324b1aa0389cf4bb12a9212025-02-03T01:04:33ZengWileyJournal of Interventional Cardiology0896-43271540-81832021-01-01202110.1155/2021/88376448837644Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New YorkThomas Bilfinger0Allison Nemesure1Robert Pyo2Jonathan Weinstein3Giridhar Korlipara4Daniel Montellese5Shamim Khan6Neal Patel7Henry Tannous8Ting-Yu Wang9Ely Gracia10Susan Callahan11Puja B. Parikh12Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USADivision of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USABackground. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods. The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results. Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions. While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.http://dx.doi.org/10.1155/2021/8837644 |
| spellingShingle | Thomas Bilfinger Allison Nemesure Robert Pyo Jonathan Weinstein Giridhar Korlipara Daniel Montellese Shamim Khan Neal Patel Henry Tannous Ting-Yu Wang Ely Gracia Susan Callahan Puja B. Parikh Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York Journal of Interventional Cardiology |
| title | Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York |
| title_full | Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York |
| title_fullStr | Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York |
| title_full_unstemmed | Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York |
| title_short | Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York |
| title_sort | distressed communities index in patients undergoing transcatheter aortic valve implantation in an affluent county in new york |
| url | http://dx.doi.org/10.1155/2021/8837644 |
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