The impact of education as a marker of socio-economic status on survival of patients after transcatheter aortic valve implantation

Introduction
An association exists between low socio-economic status (SES) and increased cardiovascular and all-cause mortality worldwide.

Aim
To evaluate the impact of educational level as a marker of socio-economic status (SES) on the clinical condition of patients before transcatheter aortic valve implantation (TAVI) and survival after TAVI.

Material and methods
We conducted a retrospective observational study involving patients with severe aortic stenosis (AS) who underwent TAVI. We divided patients based on their level of education into lower (LLE) and higher educational level (HLE) groups. We evaluated periprocedural (combined endpoints of device success (DS) and early safety (ES), according to VARC2 criteria) and mid-term outcomes (all-cause and cardiovascular mortality).

Results
Of the 379 study patients, 212 were in the LLE group. The mean follow-up was 2.1 ±1.8 years. Patients with a LLE were younger (77.4 ±7.2 vs. 79.4 ±6.5 years, p = 0.006) and more often female (58% vs. 40%, p < 0.001). They had higher body mass index (29.5 ±5.7 vs. 28.3 ±4.8, p = 0.037), more often type 2 diabetes mellitus (43% vs. 31%, p = 0.013) and moderate or severe aortic regurgitation (8% vs. 2%, p = 0.026), and some patients’ condition required urgent TAVI (5% vs. 0%, p = 0.003). There were no differences in combined procedural endpoints. The all-cause mortality during mid-term follow-up was 25% in the LLE group and 24% in the HLE group (log-rank, p = 0.941). Cardiovascular mortality was 19% in both groups (log-rank, p = 0.925).

Conclusions
Patients with an LLE required TAVI at a younger age, had more comorbidities and had a more risky profile. Level of education did not influence periprocedural and mid-term outcomes.