TAVR activity dropped, then rebounded between first, third pandemic waves
Click Here to Manage Email Alerts
Key takeaways:
- The number of TAVR procedures fell significantly during the first and second waves of the COVID-19 pandemic.
- The volume of TAVR procedures rebounded during the third wave of the pandemic.
Data from transcatheter aortic valve replacement centers across 61 countries show TAVR volume fell precipitously during the first and second waves of the COVID-19 pandemic but rebounded to pre-pandemic volume during the third wave.
In a registry analysis of 130 TAVR centers, researchers also observed substantial differences in TAVR volume during the pandemic based on geographic region, public vs. private hospital status, TAVR center volume and socioeconomic status.
Image: Adobe Stock
“Patients with symptomatic severe aortic valve stenosis necessitating surgical AVR or TAVR are especially vulnerable to treatment delays, and treatment deferral is associated with an increased risk of hospitalization and death,” Darren Mylotte, MB BCh, MD, PhD, consultant cardiologist at Galway University Hospital, Ireland, and colleagues wrote in JACC: Cardiovascular Interventions. “It is therefore concerning that single-center and regional reports have suggested reduced TAVR procedural volume during the COVID-19 pandemic. The impact of the COVID-19 pandemic on a specific procedure such as TAVR, however, is likely to have been heterogeneous across diverse countries and health care systems and has been influenced by socioeconomic and other national factors, the incidence of severe SARS-CoV-2 infection and the severity of governmental public health measures introduced in response to the pandemic.”
TAVR procedures by center
In a retrospective study, Mylotte and colleagues created a registry on global TAVR activity before and during the COVID-19 pandemic, inviting individual TAVR centers to voluntarily participate in the study. Of 292 centers invited, 130 centers from 61 countries responded (n = 65,980 TAVR procedures) and submitted the required data. Among participating centers, 66 were from Europe, 32 were from Asia, 18 were from Central or South America, eight were from North America and six were from Oceania or African countries. Most centers were public (71.5%) and urban (83.1%).
The researchers then analyzed monthly TAVR case volume for the participating institutions from 2018 to 2021, using a dedicated report template. The researchers collected hospital-level information on public vs. private, urban vs. rural and TAVR volume, as well as country-level information on socioeconomic status, COVID-19 incidence and governmental public health responses.
The researchers noted three objectives: to assess the association of the COVID-19 pandemic with global TAVR procedural volume; to study whether the pandemic differentially impacted TAVR procedural volume according to geographic region, health care system, demographic, development or economic status; and to evaluate whether the incidence of SARS-CoV-2 infection or governmental public health measures impacted TAVR procedural volume.
Researchers found that, compared with the pre-pandemic period, the first and second pandemic waves were associated with 15% and 7% reductions in TAVR procedures, respectively (P < .001 for both comparisons). The incidence rate ratio (IRR) was 0.85 during the first wave (95% CI, 0.83-0.88) and 0.93 for the second wave (95% CI, 0.91-0.95). There was no change in TAVR activity during the third wave of the pandemic (IRR = 1.01; 95% CI, 0.98-1.05; P = .43).
Researchers observed significant discrepancies in TAVR procedure reductions by geographic region, with the greatest drops seen in Africa (–52%; P = .001), Central-South America (–33%; P < .001), and Asia (–29%; P < .001). There were also greater reductions in TAVR activity among private vs. public hospitals (P = .005), urban vs. rural areas (P = .011), low-volume vs. high-volume centers (P = .002), countries with lower vs. higher development (P < .001) and economic status (P < .001).
TAVR centers where there was higher documented COVID-19 incidence also experienced a greater drop in TAVR procedures (P < .001), as did centers in areas with more stringent public health restrictions (P < .001).
“While the application of containment measures, including school and workplace closures and restrictions on public gatherings, are known to reduce the transmission of the SARS-CoV-2 infection, it is important to recognize the undesirable effects of these policies,” the researchers wrote.
Lessons learned for future pandemics
In a related editorial published in JACC: Cardiovascular Interventions, Frederick G.P. Welt, MD, MS, FACC, FSCAI, associate chief of cardiovascular medicine and director of the cath lab at University of Utah Health, and Sara J. Pereira, MD, professor of surgery in the division of cardiothoracic surgery at the University of Utah Health in Salt Lake City, noted that data show the pandemic was associated with a reduction in TAVR procedures; however, there were important discrepancies when looking at the data geographically and socioeconomically.
Additionally, reports show there were SARS-CoV-2 outbreaks in health care settings, but there were also low rates of nosocomial infections in hospitals with rigorous infection prevention programs, suggesting more can be done to prepare for future pandemics.
“With the understanding that future pandemics may have very different characteristics of spread, it seems reasonable to suggest that our public health stance not limit access to patients with potentially life-threatening cardiovascular diseases,” Welt and Pereira wrote. “After all, trading mortality from a pandemic for one from treatable cardiac conditions makes little sense.”
Reference:
Collapse
Click Here to Manage Email Alerts