Do patients in the United States have sufficient access to transcatheter aortic valve replacement (TAVR) centers? A team of researchers explored that question in detail, assessing data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry. The group shared its findings in JAMA Cardiology.
TAVR access varies from one part of the United States to the next, both as a result of federal policies and the strategic priorities of individual hospitals. What needed clarified, the authors explained, was the effect this was having on patient care.
“Understanding the importance of the trade-off between maintaining high procedural volumes to ensure quality and geographic accessibility to TAVR centers is important from a public health perspective,” wrote lead author Guillaume Marquis-Gravel, MD, MSc, Duke Clinical Research Institute in Durham, North Carolina, and colleagues. “The objective of the study was to describe the geographic availability of TAVR centers in the United States.”
UMarquis-Gravel et al. focused on U.S. census data and information on more than 31,000 patients who underwent a successful transfemoral TAVR from June 1, 2015, to June 30, 2017.
These are three key findings from the team’s study:
1. 76.7% of all hospital referral regions (HRRs) contain a TAVR center
While just 1.2% of all U.S. zip codes contain a TAVR center, one can be found in significant number of HRRs. Overall, 92.1% of individuals over the age of 65 live in a n HRR with a TAVR center.
2. The median driving time to TAVR centers is 35 minutes
The driving times were measurable for more than 31,000 patients from the TVT registry, and they ranged from two minutes to nearly 19 hours—but the median time was just 35 minutes. 100% of those patients, the authors noted, underwent the procedure in a TAVR center within their HRR.
3. A majority of TAVR centers are in urban areas
While 70.1% of the procedures occurred in an urban area, another 23.7% occurred in a suburban area—leaving 6.2% that were in rural areas.
“These results suggest that within the context of the US health care system, where certain advanced procedures and specialized care are centralized, TAVR services have significant penetration,” the authors wrote. “More studies are required to evaluate the effect of geographic location of TAVR sites on access to TAVR procedures among individuals with an indication for a TAVR within the US population.”
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.