Time From First Contact With the Heart Team to Transcatheter Aortic Valve Replacement (TAVR) and the Area Deprivation Index (ADI)

Introduction Transcatheter aortic valve replacement (TAVR) is an increasingly used form of aortic valve replacement. Prolonged wait time prior to TAVR is associated with an increased mortality rate. This study examines whether the extent of neighborhood disadvantage of patients has any impact on time to TAVR, and if so, to what degree. Methods After institutional review board approval, we conducted a retrospective review of a prospectively maintained database to assess time to TAVR. Time to TAVR was defined from first contact with the structural heart team until implant. Inclusion criteria involved patients undergoing TAVR from January 2019 until January 2024. The area deprivation index (ADI) was determined utilizing the patient’s listed home address and the Neighborhood Atlas developed by the Center for Health Disparities Research of the University of Wisconsin School of Medicine and Public Health. Results The patient population included 708 patients. No significant correlation between time to TAVR and ADI was found for patients with a time to TAVR one or two standard deviations from the mean. For patients with time to TAVR greater than three standard deviations from the mean, positive correlations were found between time to TAVR and ADI, as well as time to TAVR and national percentile. The national percentile was obtained by comparing ADI scores for the entire United States, which were then ranked and divided into percentiles. Conclusions Patients from the most disadvantaged neighborhoods experience a longer time to TAVR than others. We hypothesized that a low socioeconomic status would potentially cause barriers with follow-up; however the prolonged time to TAVR in this study was not shown to be secondary to that.