Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And joining me today to highlight neighborhood socioeconomic status and readmission in acute type A aortic dissection repair is Dr. Patricia Vassallo. She's an Assistant Professor of Medicine in Cardiology at Northwestern Medicine.

Dr. Vassallo, thank you so much for joining us today. I'd like you to give us a little background on the topic and the scope of what we're discussing here today with neighborhood socioeconomic status and readmission.

Dr Patricia Vassallo: Yes. Well, thank you for having me. So, socioeconomic status is important in outcomes for patients. And when you take a type A aortic dissection, where you have an aortic emergency, we wanted to see how socioeconomic status impacted the readmission of those patients.

Melanie Cole, MS: Such an interesting topic. I'd like you to give us the impetus. Tell us about the research itself and what prompted it.

Dr Patricia Vassallo: I'm the Medical Director of Code Aorta. Code Aorta is a multidisciplinary program to expedite surgical care for patients with life-threatening aortic emergencies. The program was designed to treat patients regardless of insurance or financial status. Because of this and the nature of aortic disease, we have seen a large number of patients coming from distressed and at-risk communities.

It was important to keep this in mind when building our program, so we could properly support our patients and especially try to prevent readmission, which is common after this surgery. We looked at our own patients, but we also wanted to look at a larger cohort of patients. What we wanted to look at was if those patients who came from a lower income have higher readmission and hospital costs compared to those living in communities with higher income.

Melanie Cole, MS: Tell us a little bit about the methods that you use to examine the relationship and how were participants selected?

Dr Patricia Vassallo: So, how do we examine socioeconomic status? In this study, we did it by looking at the median household income quartile. And then, we looked at the mortality and readmission patterns of following repair of acute type A dissections in a nationally representative registry. These adults who underwent repair of acute type A dissection were selected using the U.S. Nationwide Readmisson Database, and then stratified by the median health income quartile. We selected them based on their diagnostic and procedural code. And then, we looked at the primary endpoint of 30-day readmission. Secondary outcomes included 90 90-dayadmission. number of readmissions, and cost of transfer and readmissions.

Melanie Cole, MS: So then, tell us a little bit about the findings, Dr. Vassallo, and the takeaways of this study.

Dr Patricia Vassallo: Those patients undergoing acute type A dissection repair, the lower Income was associated with higher odds of readmission. But when we looked at the early readmissions for individuals living in the lowest income communities, it was likely more contributable to great baseline comorbidities such as kidney disease or heart failure. What we did observe, though, was that the 90-day readmission rate was associated with lower median health income quartile, regardless of their baseline comorbidities.

Melanie Cole, MS: So, I guess the important question here is how will these findings impact patient care at Northwestern Medicine and other healtcare institutions? I'd like you to take us from bench to bedside here. What are the implications of this important work?

Dr Patricia Vassallo: So, the importance of these works, this paper, is that it supports and highlight the need for aortic programs to have financial and social resources to support individuals that come from these lower socioeconomic communities. If you look at Northwestern, we built our program with this in mind. So, we leverage our hospital's transitional care clinics, which serve our uninsured and underinsured individuals.

We often provide free transportation if needed, and we make sure that these patients have the medication they need before they leave the hospital. All of our patients are given free blood pressure machines. And then when they go home, they have oversight from our nurses who check in with them often, and we can adjust their medication while they're at home.

And finally, when you have an acute type A dissection, it's imperative that you have really good followup. And so Northwestern, through the Code Aorta Program, is able to provide this followup and make sure that patients have a way to get back to clinic if needed to see them in our clinic.

Melanie Cole, MS: So then, what are the next steps of this research here at Northwestern Medicine and beyond? Where do you see this going?

Dr Patricia Vassallo: where I see it going is, first of all, Northwestern has to continue to monitor how their program is doing and how their own readmission rates are. And if they see factors that are contributing to readmission, Then we should address those factors, as best we can. Nationally, further investigation is required to determine which patient level and system level interventions are needed to reduce readmission rates. The main thing is that resources, are needed to support this endeavor.

Melanie Cole, MS: As we wrap up, Dr. Vassallo, anything else you'd like other physicians to know about the study and any questions that they might have? What would you like the key takeaways to be?

Dr Patricia Vassallo: I think the main takeaway is that socioeconomic status matters. And we have to continue to research this area and it's very applicable to other diseases. Health equity is important for everyone, but we strive at Northwestern to make sure that we're taking care of all our patients to the highest quality. And I think that if we continue to examine factors that are influencing patient outcomes, we will serve our patients better.

Melanie Cole, MS: I agree with you, and it is a really important topic when we look at the healthcare disparities out there. So, well done in really trying to tackle some of these difficult situations. And thank you again for joining us to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/cardiovascular. And that wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please always remember to subscribe, rate, and review Better Edge on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.