How population density can influence TAVR utilization, patient outcomes
Transcatheter aortic valve replacement (TAVR) procedures require a high level of precision and teams of healthcare professionals, often limiting patient access in more rural areas where resources are in short supply.
What does this mean for TAVR utilization and patient outcomes? A group of researchers aimed to answer those very questions, publishing its findings in Circulation: Cardiovascular Quality and Outcomes.
The analysis included more than 6,500 TAVR patients who were treated from 2011 to 2016 in the state of Florida. The mean patient age was 82 years old. Ninety-one percent of patients were white and 57% were male.
Overall, the research team identified clear disparities between patients who had to travel long distances for TAVR care and those who did not. Patients in high-population density areas of Florida—where most of the state’s TAVR centers are located—experienced much higher TAVR utilization rates and lower TAVR mortality rates.
Also, patients living in low-population density areas were less likely to be sent to a rehabilitation or acute care facility after treatment.
“Floridians living in more rural counties face significantly longer travel distances and times for TAVR, much lower TAVR utilization rates, and higher TAVR procedural mortality,” wrote lead author Abdulla A. Damluji, MD, PhD, MPH, Johns Hopkins University in Falls Church, Virginia, and colleagues. “This is of particular importance for vulnerable elderly for whom these phenomena may create disparities in care. The inherent trade-offs between access to TAVR, its rate of utilization, and procedural mortality are all important considerations when determining institutional and operator requirements for TAVR across the country.”
Damluji et al. also emphasized that numerous financial barriers—lower reimbursement rates and the high costs, to name two examples—limit the development of TAVR centers in more rural areas. And, they added, patient access to TAVR care in the United States is considerably superior to many other parts of the world.
“It should be noted that despite the differences in the distribution of TAVR centers by population density, racial, and ethnic factors, the United States has more TAVR programs per population than any other country,” the authors wrote. “This expansion of TAVR programs was driven by different factors including industry, hospitals/physicians, and patient advocacy groups. While there were real efforts to extend TAVR services to cover populations in need, concerns were raised regarding large profit margins and market acquisition, hospital requesting accreditation without meeting the minimum quality metrics for establishment of TAVR programs, and industry funding for advocacy groups that makes the appropriate planning for TAVR centers more challenging.”
The full analysis is available here. Click here for additional findings about patient access to TAVR centers in the United States.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.