Inequity in Access to Transcatheter Aortic Valve Replacement: A Pan-Canadian Evaluation of Wait-Times

Wijeysundera, Harindra C.; Henning, Kayley A.; Qiu, Feng; Adams, Corey; Qoofi, Faisal Al; Asgar, Anita W.; Austin, Peter C.; Bainey, Kevin R.; Cohen, Éric A.; Daneault, Benoit; Fremes, Stephen E.; Kass, Malek; Ko, Dennis T.; Lambert, Laurie; Lauck, Sandra; MacFarlane, Kendra; Nadeem, Syed Najaf; Oakes, G.; Paddock, V.; Pelletier, Marc; Peterson, Mark D.; Piazza, Nicolò; Potter, Brian J.; Radhakrishnan, Sam; Rodés‐Cabau, Josep; Toleva, Olga; Webb, John G.; Welsh, Robert C.; Wood, David; Woodward, Graham; Zimmermann, R.

doi:10.1016/j.cjca.2019.10.018

Cited by 22 publications

(13 citation statements)

References 24 publications

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“…Several hypotheses were proposed including diffusion of the technique with time, changes in FDA‐approved indications for the device, and changes in Medicare reimbursement. Unequal access to this procedure has been observed outside the US, with Canadian provinces demonstrating significant geographic disparities in TAVR performance from 2014 to 2017 12 . Our analysis revealed that Medicaid and self‐pay patients were at increased risk of prolonged LOS but not increased odds of mortality.…”

Section: Discussionmentioning

confidence: 64%

“…10 T A B L E 3 Multivariable logistic regression for hospital length of stay performance from 2014 to 2017. 12 Our analysis revealed that Medicaid and self-pay patients were at increased risk of prolonged LOS but not increased odds of mortality. An unexpected finding was that patients from the most densely populated regions were also found to be at risk for prolonged LOS.…”

Section: Discussionmentioning

confidence: 72%

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The effect of socioeconomic factors on patient outcomes in cardiac surgery

McLeish

Seadler

Parrado

et al. 2022

Journal of Cardiac Surgery

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Objectives Healthcare delivery is heterogenous; the reasons for this are numerous and complex. Patient‐specific factors including geography, income, insurance status, age, and gender have been shown to bias surgical outcomes. Utilizing a prospectively collected all‐payer database, we aim to evaluate the influence of socioeconomic factors on mortality and length of stay (LOS) after common cardiac surgical procedures. Methods We utilized the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality for the year 2019. We included patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), and combined AVR/CABG using the 10th revision of the International Classification of Diseases procedure codes. AVR and CABG were combined into a separate cohort as this was felt to represent a different pathology than isolated valvular or coronary arterial disease. Baseline demographics were summarized. Multivariable regression was performed within each procedure group to model the odds of in‐hospital mortality and hospital LOS with age, sex, insurance, zip‐code median household income, and location as predictors. Results Baseline patient characteristics including gender, income, geography, and payer status were similar between CABG, AVR, and AVR/CABG. TAVR patients had a higher proportion of female sex and Medicare as the primary payer, with an overall greater age. Multivariable Cox proportional hazards regression found that higher income was strongly associated with decreased LOS following AVR and CABG, and moderately associated in TAVR and AVR/CABG. Private insurance was associated with a decreased LOS in patients undergoing CABG, AVR, TAVR, and AVR/CABG. Female sex and increased age were associated with increased odds of mortality in TAVR, CABG, and AVR/CABG. Private insurance was associated with a decreased odds of mortality in patients undergoing AVR. Conclusions These findings reveal significant disparities in patient outcomes after routine cardiac operations that are associated with socioeconomic status. Patients who did not have private insurance or had lower incomes were found to be at risk for increased LOS. Women were at a higher risk of mortality for several operations, a finding which has been previously described elsewhere. Private insurance conveyed a decreased odds of mortality in patients undergoing AVR. This data set serves to highlight differences in healthcare outcomes based on a variety of socioeconomic, geographic, and other inherent factors. Additional research is needed to identify the mechanisms behind these disparities with the goal of providing equitable care to all patients.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 72%

The effect of socioeconomic factors on patient outcomes in cardiac surgery

McLeish

Seadler

Parrado

et al. 2022

Journal of Cardiac Surgery

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“…7 Paradoxically, data are showing a global increase in wait time for TAVR in Canada, with important provincial disparities likely related to varying provincial funding for TAVR. 8 Hospitalisations after TAVR were reduced in this study but remained high. This is another area where more data granularity would be helpful.…”

mentioning

confidence: 59%

Interpreting Administrative Data About Transcatheter Aortic Valve Replacement Effects on Hospitalisation Outcomes: The Devil’s in the Details

Simon

Asgar

2020

Canadian Journal of Cardiology

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“…Of equal concern, there is marked variation in median wait times across Canada: from 71.5 days in Newfoundland to 190.5 and 203 days in Manitoba and Alberta, respectively. 4 The inequalities highlighted in this study reflect current practice in Canada where TAVI is predominantly offered to patients of high and intermediate surgical risk. As TAVI expands to low-risk patients with increasing demand on TAVI services, these inequalities may continue to worsen.…”

Section: Current Inequalities In Tavi Carementioning

confidence: 79%