Intro: Transcatheter Aortic Valve Replacement (TAVR) is the standard of care for patients with symptomatic aortic stenosis and high surgery risk. However, access to TAVR varies and rural populations often face barriers due to limited access to cardiologists, travel burden, geographic isolation, and financial constraints. Understanding comorbidity trends helps contextualize geographic disparities among rural populations. Shasta Regional Medical Center (SRMC) serves as the closest resource for advanced cardiac procedures for Northern California north of Redding, and is why we assessed the most prevalent comorbidities, impact of rural residence, and comorbidity burden among patients receiving TAVR at SRMC. Methods: A retrospective analysis was conducted on TAVR procedures performed at SRMC from 2020-2024. Aggregate data were analyzed for comorbities including diabetes, hypertension (HTN), prior myocardial infarcion (pMI), heart failure (HF), prior percutaneous intervention (pPCI), conduction defects, and cerebrovascular accidents (CVA). Rural-Urban Commuting Area (RUCA) codes and Zip Code Tabulation Areas (ZCTA) were used to classify residence as Urban (≤3), Micropolitan (>3,≤6), or Rural (>6). Chi-square tests evaluated differences in comorbidity prevalence and NYHA functional class among groups, and t-tests assessed comorbidity burden. Institutional Review Board approval and a wavier of consent was obtained. Results: A total of 430 TAVR procedures were analyzed. HTN, diabetes, and pPCI were the most prevalent comorbidities (84.6%, 27.2%, and 20.5%, respectively). Annual trend anaylsis showed significant variation in pMI (p=0.0129) and recent HF (p<0.0001). Rural analysis (n=388) included 288 Urban, 31 Micropolitan, and 69 Rural patients. No statistically significant differences were observed in comorbidity prevalence or comorbidity burden between groups (p=0.50). However, NYHA class distribution differed significantly, with Rural and Micropolitan patients presenting in more advanced stages compared to Urban counterparts (p=0.038 and p=0.001, respectively). Conclusions: Although comorbidity burden and prevalence were similar across geographic groups, Rural and Micropolitan patients presented in more advanced NYHA class than their Urban counterparts. These findings may indicate delays in cardiac care, referral processes, or symptom reporting, and further support the need for improved outreach and referral optimization for rural populations.
Moon et al. (Tue,) studied this question.