Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation

Background: Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS. Methods: Consecutive patients undergoing TAVI for severe AS at three hospitals between August 2008 and February 2023 were prospectively enrolled in a multicentre registry. Patients were stratified into SES quintiles using a census-derived index. Demographic, procedural, and outcomes data were retrospectively analysed. Results: A total of 2,462 patients underwent TAVI during the study period. Lower SES patients were younger than those of higher SES, had more comorbidities, and were less likely to have private health insurance or receive care in private hospitals. Compared to higher SES groups, lower SES patients presented with more advanced disease markers (lower aortic valve area, lower dimensionless index, increased pulmonary hypertension) and were more likely to undergo urgent TAVI, but faced longer wait times for elective TAVI. Despite these pre-procedural differences, mortality and complication rates were similar across SES groups. In multivariable analyses, SES was not an independent predictor of mortality or major adverse cardiovascular events (MACE) at 30 days or 12 months. Conclusions: SES did not independently predict mortality or MACE in patients undergoing TAVI for severe AS. However, disparities in pre-procedural characteristics and access barriers were identified, highlighting the need to address SES-related inequities in healthcare delivery.