在具有地理和社会经济弱点的患者中进行过导管大动脉置换
Jacob M Tupa1, Hunter T Row1, Greta C Schwartz1
1School of Medicine and Health Sciences, University of North Dakota, Fargo and Grand Forks, ND, USA.
The American surgeon
|November 12, 2024
概括
超导管大动脉置换 (TAVR) 等待时间随着距离和社会脆弱性而增加,但没有影响中期生存率. 随着等待时间的延长,长期生存率下降,尽管及时的护理是可以实现的.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 过导管大动脉置换 (TAVR) 是严重的大动脉狭窄症 (AS) 的标准治疗方法.
- 现有研究尚未澄清TAVR获取或农村或社会弱势群体结果的潜在差异.
- 这项研究调查了地理位置和患者的脆弱性是否影响TAVR的结果.
研究的目的:
- 评估地理距离和社会脆弱性指数 (SVI) 对TAVR程序时间的影响.
- 评估等待时间与TAVR患者的治疗结果 (包括生存率) 之间的关联.
主要方法:
- 从2012年8月到2023年6月接受TAVR的1565名患者的回顾性分析.
- 用患者的邮政编码来确定SVI并测量到医疗机构的距离.
- 结果 (中风,TIA/妄,心脏起器植入,新的心房动/动,心肌梗塞) 和生存概率使用门学术研究联盟3 (VARC-3) 标准和卡普兰-梅尔曲线进行了评估.
主要成果:
- 居住在离该机构更远的患者在冠状动脉血管造影 (CATH) 和TAVR之间等待时间大约长了9天.
- 在CATH和TAVR之间的平均等待时间为低SVI患者71天,高SVI患者78天.
- 计算机断层扫描血管造影 (CTA) 和TAVR之间的等待时间在低 (40天) 和高 (39天) SVI组中相似.
结论:
- 旅行距离的增加与TAVR前等待时间的延长有关.
- 在CATH和TAVR之间延长的延迟与长期存活率的降低有关,但与中期存活率无关.
- 尽管存在潜在的地理和社会经济障碍,但TAVR患者可以获得及时的护理,并获得可比的结果.
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