TAVR programs concentrated in wealthier areas, raising questions about access
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There are inequities in the dispersion of transcatheter aortic valve replacement, with lower rates in poorer communities, according to a presentation.
“The increased number of TAVR programs that we found during the study period did not necessarily translate to increased access to TAVR, as TAVR sites are predominantly localized in metro areas and the majority of TAVR sites opened are in areas with preexisting programs. We found that hospitals adopting TAVR served more advantaged patients. Wealthy, more privileged patients had more access to TAVR by virtue of the hospitals that serve them,” Ashwin Nathan, MD, fellow in cardiovascular medicine at the Hospital of the University of Pennsylvania, said during a presentation at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
According to the researchers, compared with hospitals that did not establish TAVR programs, hospitals that established TAVR programs cared for fewer patients who had dual eligibility for Medicaid (P < .01), patients with higher median household incomes (P = .03) and patients from less distressed areas (P < .01).
During the study period of 2012 to 2018, only 11 TAVR programs were established in nonmetropolitan areas. In the analysis, 554 hospitals developed new TAVR programs, 98% in metropolitan areas and 53% in metropolitan areas with preexisting TAVR programs.
According to the researchers, distressed areas of the country tended to have a higher rate of surgical AVR vs. TAVR.
There were fewer TAVR procedures per 100,000 Medicare beneficiaries in areas with more Medicaid dual-eligible patients, lower average median household incomes and more average community distress (P < .01 for all), according to the researchers. TAVR rates per 100,000 Medicare beneficiaries were higher in regions with higher median income, despite adjusting for age and clinical comorbidities, Nathan and colleagues found.
According to the researchers, compared with hospitals that did not start TAVR programs, hospitals that established them treated patients with higher median household incomes (difference, $1,305; 95% CI, 134-12,477; P =.03).
“For future studies, we seek to identify the role of race and ethnicity in the inequitable access to TAVR, to identify system- and patient-level barriers to access and to develop and test solutions to address these inequities and inequitable care,” Nathan said during his presentation.
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Nathan A, et al. Featured Clinical Research: Stable ischemic heart disease and TAVR. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).
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