Distressed Communities Have Worse Long-Term Survival After Aortic Valve Replacement

INTRODUCTION: Socioeconomic status can affect outcomes following cardiac surgery. The Distressed Communities Index (DCI) is a comprehensive comparative measure for economic well-being. This study aimed to explore the association of DCI scores and outcomes following surgical aortic valve replacement (SAVR). METHODS: Seven humdred forty-six consecutive patients who underwent SAVR at our Institution from 2012 to 2020 were retrospectively reviewed. These patients were categorized into 2 groups based on their DCI scores: distressed (DCI>80 [n = 144]) and nondistressed (DCI ≤ 80 [n = 602]). Key variables were used for a 1:1 propensity-match, followed by Kaplan-Meier and conditional survival analyses. Multivariable Cox regression models were also constructed in both unmatched and matched cohorts to evaluate the independent association between DCI and survival. RESULTS: Before matching, the distressed group had a significantly lower median age (61.0) as well as a higher median Society of Thoracic Surgeons risk score (2.13%) compared to the nondistressed group (65.0, 1.74%, P = 0.0253, P = 0.0031). Kaplan-Meier estimated mortality was also significantly higher for the distressed group (P = 0.0004). After matching, 144 patients were identified in each group, with all standardized mean differences less than 0.10. Kaplan-Meier estimated mortality remained significantly higher for the distressed group in this matched cohort (P = 0.03). Multivariable Cox regression also confirmed DCI>80 was independently associated with higher mortality in both cohorts. CONCLUSIONS: These findings reveal that distressed DCI scores correlate with worse clinical outcomes post-SAVR. These survival disparities highlight a need for improved patient care and suggest that DCI could be a useful tool for better risk stratification and postdischarge planning to improve outcomes for high-risk populations.