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

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).

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.

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.

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.