Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar:39:100370.
doi: 10.1016/j.ahjo.2024.100370. Epub 2024 Feb 23.

Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement

Ikeoluwapo Kendra Bolakale-Rufai  1 , Alexander Shinnerl  2 , Shannon M Knapp  1 , Amber E Johnson  3 , Selma Mohammed  4 , LaPrincess Brewer  5 , Asad Torabi  1 , Daniel Addison  6 , Sula Mazimba  7 , Khadijah Breathett  1
Affiliations

Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement

Ikeoluwapo Kendra Bolakale-Rufai et al. Am Heart J Plus. 2024 Mar.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis.

Methods and results: Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates.

Results: Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)].

Conclusions: Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.

Keywords: Aortic stenosis; Emergency; Healthcare delivery; Social determinants of health; Social vulnerability index; Valve replacement; Valve surgery.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Dr. Khadijah Breathett is an Editorial Board Member for American Heart Journal and was not involved in the editorial review or the decision to publish this article.

Figures

Fig. 1
Fig. 1
Flow chart for patient selection.
Fig. 2
Fig. 2
Odds of receiving an urgent TAVR in AS based on SVI. The SVI Quintile group is along the Y axis (Quintile 1 is the referent SVI with lowest social vulnerability; Quintile 5 has the greatest social vulnerability). The odds of receiving an urgent TAVR in AS is on the X axis. AS indicates Aortic Stenosis; SVI, Social Vulnerability Index; TAVR, Transcatheter aortic valve replacement.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ross J., Braunwald E. Aortic stenosis. Circulation. 1968;38(1s5) doi: 10.1161/01.CIR.38.1S5.V-61. (V-61) - DOI - PubMed
    1. Arnold S.V. Calculating risk for poor outcomes after transcatheter aortic valve replacement. J. Clin. Outcomes Manag. 2019;26(3):125–129. - PMC - PubMed
    1. Leon M.B., Mack M.J., Hahn R.T., et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J. Am. Coll. Cardiol. 2021;77(9):1149–1161. doi: 10.1016/j.jacc.2020.12.052. - DOI - PubMed
    1. Chen K, Polcari K, Michiko T, et al. Outcomes of urgent transcatheter aortic valve replacement in patients with acute decompensated heart failure: a single-center experience. Cureus. 12(9):e10425. doi:10.7759/cureus.10425. - DOI - PMC - PubMed
    1. Optum Clinformatics Data Mart for IU Researchers Data: social science research commons: Indiana University Bloomington. 2023. https://ssrc.indiana.edu/data/optum.html Accessed July 17.