Background. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods. The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results. Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions. While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.

中文翻译：

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纽约富裕县接受经导管主动脉瓣植入术患者的痛苦社区指数

背景。贫困社区指数 (DCI) 是一种基于美国邮政编码的经济福祉综合衡量标准，其临床影响正日益得到认可。从 0（繁荣）到 100（苦恼），DCI 与心血管结局的关联仍然未知。我们旨在研究在纽约一个富裕县接受经导管主动脉瓣介入治疗 (TAVR) 的严重症状性主动脉瓣狭窄 (AS) 成人患者的表现和结局与 DCI 的关系。方法. 研究人群包括 286 名患有严重症状性 AS 或生物瓣膜变性的患者，他们于 2015 年 12 月至 2018 年 6 月在一家学术三级医疗中心接受了带有新一代经导管心脏瓣膜 (THV) 的 TAVR。每个患者的 DCI 来自他们的主要居住地邮政编码。将患者分为 DCI 十分位数，然后分为 4 组。主要和次要结局分别是 30 天、1 年和 3 年死亡率。结果。在研究的 286 名患者中，26%、28%、28% 和 18% 分别被分类为 DCI 组 1-4（DCI <10：n  = 73；DCI 10-20：n  = 81；DCI 20-30：n  = 80；DCI >30：n = 52)。与第 1 组和第 2 组的患者相比，第 4 组的患者更年轻，肾功能更差。他们的主动脉瓣环更小，更有可能接受更小的 THV。住院时间或住院、30 天、1 年和 3 年死亡率分布没有显着差异。结论。虽然 DCI 与临床和解剖学特征的差异有关，但在这项对接受 TAVR 的成人的前瞻性观察性研究中，它与临床结果的差异无关，这表明获得护理是可能的鉴别因素。