New data put a spotlight on troubling TAVR trends
Philippe Genereux, MD, director of the structural heart program at Morristown Medical Center and principal investigator of the EARLY TAVR trial, spoke to Cardiovascular Business at TCT 2024 about how his team's findings highlight troubling trends in healthcare. EARLY TAVR showed that early treatment for asymptomatic patients with severe aortic stenosis (AS) can improve outcomes, but it also served as a reminder that AS is such a deadly disease because so many patients never receive proper care. There are even times when when an echo is ordered and a patient qualifies for transcatheter aortic valve replacement (TAVR), but they still go untreated.
This is a big enough issue that the American Heart Association (AHA) created the Target: Aortic Stenosis Program to raise awareness and ensure AS patients are followed up with and get the treatment they need. The program consists of evidence-based measurements developed to better identify and treat patients as well as educational resources for people living with structural heart disease. The AHA is planning to double the size of the program, which currently includes 41 hospitals.
Genereux hopes EARLY TAVR will help boost awareness about undertreatment and bring about real change among cardiologists
"I think the message is, as soon as a patient has severe aortic stenosis, they should be referred. And we should treat the patient as soon as possible. That's going to help the undertreatment," Genereux explained. "About 50% of the patients in the community that already have severe AS with symptoms are not treated and they are waiting."
He said this ongoing undertreatment trend is a significant problem that needs to be addressed.
"There are a lot of patients with severe AS with symptoms who are not being treated, and this is why this is still a deadly disease," he said.
The other lesson from the trial is that early referral and treating the patient when they do not have any symptoms will help the healthcare system by being more efficient and lower costs, compared to waiting until the patient is extremely sick and then intervening.
"You don't treat them when they crash and burn. You don't want them to stay a long time in the hospital. When you have a brief hospitalization, you have less complications. So all of that will reduce the healthcare costs, the use of healthcare resources, and we're going to be able to plan our care better. This is a progressive and dead disease, it's not a disease where we can wait and sit on it, especially when there are symptoms," Genereux said.
TAVR has grown rapidly over the past decade and now makes up more than 80% of aortic valve replacements in the U.S. The patient population being treated has also grown because many patients before TAVR either did not want to undergo open heart surgery, or their physicians never referred them for surgery because they were unsure the patient was healthy enough to undergo the procedure.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com