The number of TAVR sites has almost tripled in recent years, but quality issues persist

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By exploring the Transcatheter Valvular Therapy (TVT) registry, an American database developed by the Society of Thoracic Surgeons and the American College of Cardiology, Valle et al. found that the number of active TAVR sites increased from 198 in 2011 to 559 in 2017. Three TAVR sites were excluded from this analysis due to a lack of data, dropping this final number to 556. In addition, the number of referral hospital regions (HRRs) without TAVR site increased from 58.2% to 17.9%.

One of the main findings of the team’s analysis was the change in the median time required to move from an existing TAVR site to a newly constructed TAVR site. That number has dropped significantly, from 403 minutes in 2011 to just 26 minutes in 2017.

The authors also examined each site’s volume, site-population density, and results, noting that high-density sites were associated with both lower procedural risk and high mortality risk.

“Taken together, these results suggest that the proliferation of TAVR centers occurred unevenly,” the authors wrote. “The subsequent impact of this uneven distribution on the volumes and density of sites may have had unintended influences on the quality of the procedure and the outcome for the patients.”

Valle et al. noted that, in order to help make more services available in rural areas, certain “minimums and procedural requirements” that had been put in place previously have been changed. Could this have led to a decline in the quality of patient care offered in these areas?

“An ongoing study is needed to identify interventions that may mitigate current results,” the authors wrote. “Data from integrated health care systems such as the Veterans Health System suggests that through geographic needs assessment for new sites and rigorous quality and safety monitoring, low-cost programs volume can still show favorable results. Recent initiatives by the TVT registry to use new methods to assess quality and performance at the local level may represent important first steps in such efforts.

Read the full analysis here.


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