Transcatheter aortic valve replacement (TAVR) has skyrocketed in popularity in recent years, becoming a go-to treatment option for many patients with symptomatic severe aortic stenosis (AS).
According to a new study in Circulation: Cardiovascular Quality and Outcomes, however, its availability in the United States is still primarily being seen hospitals that serve wealthier patients.
“Prior studies have demonstrated that patients living in rural environments are underrepresented among those patients undergoing TAVR, and there are concerns that geographic, racial, and socioeconomic factors may contribute to inequities in access to TAVR,” wrote lead author Ashwin S. Nathan, MD, MS, of the Perelman Center at Hospital of the University of Pennsylvania in Philadelphia, and colleagues. “In fact, TAVR may be particularly sensitive to propagating inequities in care, given the need for multiple treating physicians, extensive specialized preprocedural testing, and surgical and interventional site-volume requirements for centers seeking to offer this therapy.”
To learn more about this topic, Nathan et al. explored Medicare data related to TAVR procedures that occurred from 2012 to 2018. The group also tracked how many hospitals developed TAVR programs during that time.
Overall, the group found that more than 37,000 different ZIP codes included at least 10 Medicare fee-for-service beneficiaries 66 years old or older who underwent TAVR during the time period in question. While more than 30,000 of those ZIP codes were assigned to a core-based statistical area, the remaining patients were categorized as being rural. The mean number of TAVR procedures performed per 100,000 Medicare beneficiaries was 308.2 in metropolitan zip codes, 320.2 in “micropolitan” ZIP codes and 307.7 in rural ZIP codes.
Also, of the 583 hospitals that developed a new TAVR program, 98.1% were developed in metropolitan areas. And hospitals with new TAVR programs tended to treat patients with a higher median household income.
“Since TAVR has demonstrated superiority over existing therapeutic options for AS, particularly in patients at unacceptably high risk for surgical aortic valve replacement, the limited availability of this procedure for disadvantaged subsets of the population likely contributed to inequities in health,” the authors wrote. “Strategies to address these inequities, whether they result from differences in referral for TAVR, patient willingness to undergo TAVR or provider willingness to perform TAVR are imperative to mitigate resulting healthcare disparities and are important areas of future inquiry.”
The group also said that TAVR services “may be only one, small facet of a much larger problem of inadequate access to primary care and diagnostic cardiology services among disadvantaged populations.”
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.