June 1, 2022Open Access
View Full PaperSocioeconomic Status and Risk of Bleeding After Mechanical Aortic Valve Replacement
Structured PICO
Does lower socioeconomic status increase the risk of hospitalization for a bleeding event in patients who underwent mechanical aortic valve replacement?
P
Population
5,974 patients aged 18-70 years who underwent mechanical aortic valve replacement (AVR) in Sweden from 1997 to 2018.
I
Intervention
Lower socioeconomic status (lowest household disposable income quartile, Q1)
C
Comparator
Higher socioeconomic status (higher household disposable income quartiles, Q3 and Q4)
O
Outcome
Hospitalization for a bleeding eventsafety
Lower socioeconomic status is strongly associated with an increased risk of bleeding and intracranial hemorrhage death following mechanical aortic valve replacement, suggesting a need for optimized anticoagulation strategies in this vulnerable population.
Abstract
BACKGROUND: Whether low socioeconomic status (SES) is associated with increased risk of anticoagulation-related adverse events in patients with mechanical heart valves is unknown. OBJECTIVES: This study sought to investigate the impact of patients' SES on the risk of bleeding after mechanical aortic valve replacement (AVR). METHODS: This nationwide population-based cohort study included all patients aged 18-70 years who underwent mechanical AVR in Sweden from 1997 to 2018. Data were obtained from the SWEDEHEART register and other national health data registers. The exposure was quartiles of household disposable income. The primary outcome was hospitalization for a bleeding event. RESULTS: Among 5974 patients, the absolute risk for bleeding after 20 years of follow-up was 20% (95% CI: 17%-24%) in the lowest income quartile (Q1) and 16% (95% CI: 13%-20%) in the highest quartile (Q4). The risk of bleeding decreased with increasing income level and was significantly lower in patients in income level Q3 (HR: 0.77; 95% CI: 0.60-0.99) and Q4 (HR: 0.68; 95% CI: 0.50-0.92) than Q1. The risk of death from intracranial hemorrhage was five times higher in the lowest income quartile than the age- and sex-matched general Swedish population (standardized mortality ratio: 5.0; 95% CI: 3.3-7.4). CONCLUSIONS: We observed a strong association between SES and risk of bleeding among patients who underwent mechanical AVR. These findings suggest suboptimal anticoagulation treatment in patients with lower SES and the need for strategies to optimize anticoagulation treatment in patients with a mechanical heart valve. (Health-Data Register Studies of Risk and Outcomes in Cardiac Surgery HARTROCS; NCT02276950).