The number of sites performing transcatheter aortic valve replacement (TAVR) in the United States nearly tripled from 2011 to 2017, according to new findings published in the Journal of the American College of Cardiology. However, researchers noted, the distribution of these sites has been uneven, continuing a trend that has been seen in the expansion of other services over the years.
“The diffusion of other novel procedures and services has not necessarily occurred ‘rationally,’” wrote lead author Javier A. Valle, MD, a cardiologist at Rocky Mountain Regional Veterans Affairs Medical Center in Denver, and colleagues. “For example, the proliferation of sites performing percutaneous coronary intervention (PCI) occurred with marked geographic differences in the ratio of sites offering PCI to the population served. If similar patterns are occurring with TAVR expansion, an imbalanced concentration of sites could be deleterious.”
Exploring the Transcatheter Valvular Therapy (TVT) registry, a U.S. database developed by the Society of Thoracic Surgeons and American College of Cardiology, Valle et al. found that the number of active TAVR sites had increased from 198 in 2011 to 559 in 2017. Three TAVR sites were excluded from this analysis due a lack of data, dropping that final number to 556. Also, the number of hospital referral regions (HRRs) without a TAVR site dropped from 58.2% to 17.9%.
One key finding from the team’s analysis was the shift in the median time it takes to drive from an existing TAVR site to a newly built TAVR site. That number has decreased dramatically, dropping from 403 minutes in 2011 to just 26 minutes in 2017.
The authors also examined each site’s volume, site-to-population density and outcomes, noting that high-density sites were linked to both a lower procedural risk and an elevated mortality risk.
“Taken together, these results suggest that the proliferation of TAVR centers has occurred unevenly,” the authors wrote. “The subsequent impact of this uneven distribution on volumes and site density may have had unintended influences on procedural quality and patient outcomes.”
Valle et al. noted that, in order to help more services be made available in rural areas, certain “procedural minimums and requirements” that had previously been put in place were modified. Could this have ultimately led to a drop in the quality of patient care being offered in these areas?
“Ongoing study is needed to identify interventions that can mitigate the present findings,” the authors wrote. “Data from integrated health care systems such as the Veterans Affairs Healthcare System suggest that through geographic needs-assessment for new sites and rigorous monitoring of quality and safety, low-volume programs may still demonstrate favorable outcomes. Recent initiatives from the TVT registry to use novel methods to assess quality and outcomes at a local level may represent important first steps in such efforts.”
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.