经导管主动脉瓣植入术后 5924 名患者的婚姻状况、教育程度与中期死亡风险。

European heart journal open Pub Date : 2024-09-12 eCollection Date: 2024-09-01 DOI:10.1093/ehjopen/oeae077
Maria Lachonius, Kok Wai Giang, Pétur Pétursson, Oskar Angerås, Kristofer Skoglund, Anders Jeppsson, Susanne J Nielsen
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引用次数: 0

摘要

目的:对于接受经主动脉瓣植入术(TAVI)的老年患者,社会因素与中期预后之间的关系知之甚少。本研究旨在探讨经主动脉瓣置换术后患者的婚姻状况、教育水平与死亡率风险之间的关系:从SWEDEHEART登记中确定了2014-2020年间在瑞典接受TAVI手术的年龄≥65岁的患者。社会因素和合并症从强制性国家登记处收集。Cox回归模型对基线合并症、年龄、性别、接受TAVI的年份、社会因素和吸烟进行了调整,用于估算死亡风险。中位随访时间为 1.9 年(四分位间范围:0.9-3.3)。共纳入 5924 名患者(47.3% 为女性),平均年龄为 82.1 岁(标准差:6.1)。在随访期间死亡的 1410 人(23.8%)中,721 人(51.2%)与心血管疾病有关。教育程度低的患者(12 年;调整后危险比(aHR):1.20,95% 置信区间(CI):1.03-1.41]。与已婚/同居者相比,从未结婚/同居者的死亡风险更高(aHR:1.32,95% 置信区间:1.05-1.65)。对男性和女性的单独分析表明,从未结婚的男性的风险增加(aHR:1.63,95% CI:1.23-2.14),但从未结婚的女性的风险没有增加(aHR:0.85,95% CI:0.56-1.30):结论:社会因素的不利因素与老年患者TAVI术后死亡风险的增加有关。这些发现强调了制定策略以提高具有不利社会因素的老年患者TAVI术后健康素养和社会支持的重要性。
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Marital status, educational level, and mid-term mortality risk in 5924 patients after transcatheter aortic valve implantation.

Aims: There is scarce knowledge about the association between social factors and mid-term outcome in older patients undergoing transaortic valve implantation (TAVI). Our aim in this study is to explore associations between marital status, educational level, and mortality risk in patients after TAVI.

Methods and results: Patients aged ≥65 who underwent TAVI in Sweden during 2014-2020 were identified from the SWEDEHEART registry. Social factors and comorbidities were collected from mandatory national registries. Cox regression models adjusted for baseline comorbidities, age, sex, year of TAVI, social factors, and smoking were used to estimate mortality risk. Median follow-up was 1.9 years (interquartile range: 0.9-3.3). Overall, 5924 patients were included (47.3% women), with a mean age of 82.1 years (standard deviation: 6.1). Of the 1410 (23.8%) deaths during follow-up, 721 (51.2%) were related to cardiovascular causes. Patients with low education (<10 years) had a higher risk of mortality than patients with the highest education level [>12 years; adjusted hazard ratio (aHR): 1.20, 95% confidence interval (CI): 1.03-1.41]. Never being married/cohabiting was associated with an increased risk of mortality in comparison with being married/cohabiting (aHR: 1.32, 95% CI: 1.05-1.65). A separate analysis of men and women showed an increased risk among never-married men (aHR: 1.63, 95% CI: 1.23-2.14) but not among never-married women (aHR: 0.85, 95% CI: 0.56-1.30).

Conclusion: Disadvantage in social factors was associated with an increased mortality risk after TAVI in older patients. These findings emphasize the importance of developing strategies to increase health literacy and social support after TAVI in older patients with unfavourable social factors.

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