Cracking the Zip Code: Uncovering the Link Between Socioeconomic Status and Transcatheter Aortic Valve Replacement Outcomes

INTRODUCTION: There is a well-known correlation between lower socioeconomic status and health outcomes. Patient zip codes and the Centers for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) can be surrogates for income and socioeconomic status to compare outcomes following transcatheter aortic valve replacement (TAVR). METHODS: We performed a retrospective study among patients who underwent TAVR at the University of Illinois at Chicago (UIC) in Chicago, Illinois, between March 2018 and June 2023. Using income data from the Census Bureau and the SVI, we assigned patients to two income groups: lower (LIG) or higher (HIG). Primary outcomes were composite major adverse cardiac events (MACE) (consisting of cardiovascular death, myocardial infarction, or cerebrovascular accident) and all-cause death. Secondary outcomes included congestive heart failure exacerbations and major bleeding events. Outcomes were analyzed at 30 days, 6 months, and 12 months. RESULTS: We analyzed 276 patients; the LIG comprised 222 (80%) of these patients. No significant differences between groups were found in the primary or secondary outcomes post-TAVR at the 6- or 12-month interval. There were significant differences in SVI between those experiencing bleeding events at 12 months. There were no differences in primary outcomes between racial groups in a subanalysis. CONCLUSION: Following TAVR, patients in the LIG and HIG had no differences in adverse events at 6 and 12 months post-TAVR. Patients in regions with higher SVI (more vulnerable regions) had higher periprocedural bleeding events.