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.