The Effect of Psychosocial Risk Factors on Outcomes After Aortic Valve Replacement

Paige Newell, Cheryl Zogg, Hugh Shirley, Jessica Feliz, Sameer Hirji, Morgan Harloff, Mariam Kerolos, Pinak Shah, Tsuyoshi Kaneko

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Psychosocial risk factors (PSRFs) have emerged as important nontraditional risk factors that are associated with worse surgical outcomes but have not been well-characterized in valvular disease. Objectives: This study evaluates the impact of PSRFs on 30-day outcomes following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Methods: All adult patients (≥18 years of age) who underwent isolated TAVR or SAVR in the Nationwide Readmissions Database from 2016 to 2018 were included. Patients were classified as having 0 PSRFs vs ≥1 PSRF. PSRFs included limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, or uninsured status. Primary outcomes included 30-day mortality, readmission, and composite morbidity (stroke, pulmonary embolus, pacemaker implantation, bleeding complications, acute kidney injury, myocardial infarction, or new atrial fibrillation). Results: A nationally weighted total of 74,763 SAVR and 87,142 TAVR patients met inclusion criteria. For SAVR, patients with PSRFs had significantly higher 30-day mortality (4.2% vs 3.7%; P = 0.048) and readmissions (13.1% vs 11.3%; P < 0.001), but there was no difference in composite morbidity. For TAVR, patients with PSRFs had significantly higher 30-day readmission (11.7% vs 10.7%; P = 0.012) but no difference in 30-day mortality or composite morbidity. On risk-adjusted analysis, presence of PSRFs was a significant predictor of higher 30-day readmissions following SAVR (adjusted OR: 1.10; 95% CI: 1.02-1.19). Conclusions: The presence of PSRFs is associated with worse short-term outcomes following SAVR and TAVR, with a more profound impact in SAVR. This study highlights the importance of identifying at-risk patients and suggests that TAVR may be beneficial in patients with less social support.

Original languageEnglish
Pages (from-to)2326-2335
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume15
Issue number22
DOIs
StatePublished - Nov 28 2022

Keywords

  • SAVR
  • TAVR
  • aortic valve replacement
  • psychosocial risk factors
  • social support

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