Socio-economic status and outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

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Abstract
Background: Transcatheter aortic valve implantation (TAVI) procedures to treat severe aortic stenosis are rising, in line with aging populations and advancements in healthcare access. Economic development correlates with AS mortality rates. Socio-economic status (SES), defined by social and economic factors such as median household income, significantly influences cardiovascular outcomes. This study analyses the impact of SES on TAVI outcomes. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Medline, Embase, Cochrane, ClinicalTrials.gov and Google Scholar, including literature up to August 1, 2024. The search employed keywords related to SES and TAVI. Of 393 identified studies, 127 were selected for full-text review, with ten addressing SES effects post-TAVI. Most studies had a retrospective design. Results: The patient cohort comprised 319,557 individuals, (144,583 from low SES backgrounds and 174,974 from high SES backgrounds). The analysis revealed a higher burden of comorbidities in low SES patients. Post-TAVI, lower SES related to increased 30-day mortality, major adverse cardiovascular events and the need for pacemaker implantation, although it did not affect in-hospital mortality or 30-day readmission rates. Conclusion: These findings underscore the substantial socio-economic disparities in TAVI outcomes and highlight the need for specific interventions to improve care for patients from less advantaged backgrounds. Key Learning Points: A. What is already known: Lower SES negatively impacts cardiovascular outcomes due to disparities in healthcare access and comorbidities. TAVI is the standard treatment for severe aortic stenosis, especially in elderly patients. SES influences outcomes in cardiovascular procedures, but its impact on TAVI was unclear. B. What this study adds: Low SES increases 30-day mortality, MACE, and pacemaker implantation rates after TAVI. SES does not affect in-hospital mortality or 30-day readmissions. Highlights the need for standardized SES metrics in TAVI research.

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