Expansion of transcatheter aortic valve replacement in the United States - 09/03/21
, Mary Vaughan Sarrazin, PhD a, b, Milind Desai, MD c, Samir Kapadia, MD c, Peter Cram, MD d, Saket Girotra, MD, SM a, bRésumé |
Background |
Patterns of diffusion of TAVR in the United States (U.S.) and its relation to racial disparities in TAVR utilization remain unknown.
Methods |
We identified TAVR hospitals in the continental U.S. from 2012-2017 using Medicare database and mapped them to Hospital Referral Regions (HRR). We calculated driving distance from each residential ZIP code to the nearest TAVR hospital and calculated the proportion of the U.S. population, in general and by race, that lived <100 miles driving distance from the nearest TAVR center. Using a discrete time hazard logistic regression model, we examined the association of hospital and HRR variables with the opening of a TAVR program.
Results |
The number of TAVR hospitals increased from 230 in 2012 to 540 in 2017. The proportion of the U.S. population living <100 miles from nearest TAVR hospital increased from 89.3% in 2012 to 94.5% in 2017. Geographic access improved for all racial and ethnic subgroups: Whites (84.1%-93.6%), Blacks (90.0%- 97.4%), and Hispanics (84.9%-93.7%). Within a HRR, the odds of opening a new TAVR program were higher among teaching hospitals (OR 1.48, 95% CI 1.16-1.88) and hospital bed size (OR 1.44, 95% CI 1.37-1.52). Market-level factors associated with new TAVR programs were proportion of Black (per 1%, OR 0.78, 95% CI 0.69-0.89) and Hispanic (per 1%, OR 0.82, 95% CI 0.75-0.90) residents, the proportion of hospitals within the HRR that already had a TAVR program (per 10%, OR 1.07, 95% CI 1.03-1.11), P <.01 for all.
Conclusion |
The expansion of TAVR programs in the U.S. has been accompanied by an increase in geographic coverage for all racial subgroups. Further study is needed to determine reasons for TAVR underutilization in Blacks and Hispanics.
Le texte complet de cet article est disponible en PDF.Plan
Vol 234
P. 23-30 - avril 2021 Retour au numéro
Article précédent
- Acute kidney injury after radial or femoral artery access in ST-segment elevation myocardial infarction: AKI-SAFARI
- Jeffrey A. Marbach, George Wells, Pietro Di Santo, Derek So, Aun-Yeong Chong, Juan Russo, Marino Labinaz, Alexander Dick, Michael Froeschl, Christopher Glover, Benjamin Hibbert, Jean-Francois Marquis, Andrea MacDougall, Malek Kass, Vernon Paddock, Ata ur Rehman Quraishi, Jaya Chandrasekhar, Nina Ghosh, Jordan Bernick, Michel Le May
- An immediate or early invasive strategy in non-ST-elevation acute coronary syndrome: The OPTIMA-2 randomized controlled trial
- Nick D. Fagel, Giovanni Amoroso, Maarten A. Vink, Ton Slagboom, René J. van der Schaaf, Jean-Paul Herrman, Mark S. Patterson, Erik F.J. Oosterwerff, Nicola S. Vos, Freek W.A. Verheugt, Jan G.P. Tijssen, Robbert J. de Winter, Robert K. Riezebos
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?