Clinical Edge

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TAVR services are accessible to most older adults in the United States

Key clinical point: TAVR services are accessible to most older adults in the United States within their hospital referral region.

Major finding: The median driving time to a TAVR center was 35 minutes (ranging from 2.0 minutes to 18 hours and 48 minutes).

Study details: The data come from U.S. Census data on 47,527,537 individuals aged 65 and older including 31,098 patients who underwent transfemoral TAVR.

Disclosures: The study was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and The Society of Thoracic Surgeons National Database. Lead author Dr. Marquis-Gravel disclosed training grant from the Canadian Institute of Health Research, personal fees from Servier, and honoraria from Novartis.

Commentary

High transcatheter aortic valve replacement (TAVR) procedural volumes have been shown to be associated with better clinical outcome in numerous studies. A reasonable institutional volume has been set as condition for CMS reimbursement to ensure adequate care which may exclude some hospitals from offering TAVR service. This observational study of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry analyzed the geographic access to TAVR centers for Medicare patients utilizing Google Maps. 92.1% of patients undergoing TAVR lived in a hospital referral region containing a TAVR center. Median driving time to implanting TAVR center was 35.0 minutes (IQR, 20.0-70.0 minutes), ranging from 2.0 minutes to 18 hours and 48 minutes.

The study demonstrates the significant penetration of TAVR procedure in the United States. Unlike some of the other specialized and advanced procedures, TAVR procedures have become easily accessible to various regions rather than centralized.”

Luke Kim, MD

Weill Cornell Medical College/New York Presbyterian Hospital

Citation:

Marquis-Gravel G et al. JAMA Cardiol. 2020 June 10. doi:10.1001/jamacardio.2020.1725.