Wait times for both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are on the rise, according to new research published in Circulation: Cardiovascular Interventions. The trend has been linked to increasing mortality among patients awaiting care.
The study’s authors tracked data from more than 22,000 patients with severe aortic stenosis (AS) who were referred for either SAVR or TAVR. All patients were treated at one of eleven tertiary centers in Canada from April 1, 2012, to March 31, 2018.
Overall, TAVR patients had a median wait time of 84 days and SAVR patients had a median wait time of 50 days. Year over year, the authors noted a “statistically significant” increase in wait time for all patients with severe AS.
Women and younger patients experienced longer wait times, as did individuals with more comorbidities.
Also, the mortality rate for patients awaiting TAVR was 5.2%, considerably higher than the 1.05% for patients awaiting SAVR—and mortality rates have been rising year after year.
Heart failure hospitalization rates are also trending in the wrong direction, and the rates were 7.7% for TAVR patients and 1.3% for SAVR patients.
So what explains this shift in patient care? When it comes to TAVR specifically, the authors emphasized, the industry has simply been unable to keep up.
“The increasing demands, reflected by the increasing referrals for TAVR, has outpaced the growth in capacity,” wrote lead author Omar T. Albassam, MD, of the University of Toronto, and colleagues. “This mismatch between demand and supply is captured by a progressively growing wait list.”
When looking at SAVR delays, the authors are less certain. They did, however, offer some potential explanations.
“First, it might be that many patients who ultimately undergo SAVR are initially triaged to TAVR and thus undergo the longer TAVR workup,” the authors wrote. “Second, there has been an increase in overall AS referrals, for both TAVR and SAVR. Some of the incremental increase in referral volumes may be a reflection of the aging demographic and as such, an increase in the incidence of AS. We think that the emergence of TAVR has also made referral for management of AS more liberal.”
The team did point to some of the study’s limitations. It was an observational analysis, for instance, and only patients with severe AS were included. Even with these limitations in mind, however, the analysis helped spotlight a key area that healthcare providers must take seriously.
“Our results are a call to clinicians, administrators and policy makers to focus on the area of access to care for AS to address this growing healthcare issue,” Albassam and colleagues concluded.
Click here to view the full study.