Key result
Transcatheter aortic valve replacement rates increased annually by 10% (IRR 1.10) while surgical aortic valve replacement rates decreased by 5% across Swiss regions between 2013 and 2018.
Why the study?
Severe aortic valve stenosis is treated with TAVR or SAVR, but temporal trends, regional variation, and potential determinants of geographic variation across Switzerland required evaluation.
Observational (n=19,899)
Yes
In Switzerland from 2013 to 2018, TAVR utilization steadily increased at the expense of SAVR, with low to moderate regional variation largely driven by socioeconomic factors rather than medical need.
BACKGROUND: Aortic valve stenosis (AS) is the most common valvular heart disease and if severe, is treated with either transcatheter (TAVR) or surgical aortic valve replacement (SAVR). We assessed temporal trends and regional variation of these interventions in Switzerland and examined potential determinants of geographic variation. METHODS: We conducted a population-based analysis using patient discharge data from all Swiss public and private acute care hospitals from 2013 to 2018. We generated hospital service areas (HSAs) based on patient flows for TAVR. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). Using multilevel regression, we calculated the influence of calendar year and regional demographics, socioeconomic factors (language, insurance status), burden of disease, and number of cardiologists/cardiovascular surgeons on geographic variation. RESULTS: Overall, 8074 TAVR and 11,825 SAVR procedures were performed in 8 HSAs from 2013 to 2018. Whereas the age-/sex-standardized rate of TAVR increased from 12 to 22 procedures/100,000 persons, the SAVR rate decreased from 33 to 24 procedures during this period. After full adjustment, the predicted TAVR and SAVR rates varied from 12 to 22 and 20 to 35 per 100,000 persons across HSAs, respectively. The regional procedure variation was low to moderate over time, with a low overall variation in TAVR (EQ 1.9, SCV 3.9) and SAVR (EQ 1.6, SCV 2.2). In multilevel regression, TAVR rates increased annually by 10% and SAVR rates decreased by 5%. Determinants of higher TAVR rates were older age, male sex, living in a German speaking area, and higher burden of disease. A higher proportion of (semi)private insurance was also associated with higher TAVR and lower SAVR rates. After full adjustment, 10.6% of the variance in TAVR and 18.4% of the variance in SAVR remained unexplained. Most variance in TAVR and SAVR rates was explained by language region and insurance status. CONCLUSION: The geographic variation in TAVR and SAVR rates was low to moderate across Swiss regions and largely explained by differences in regional demographics and socioeconomic factors. The use of TAVR increased at the expense of SAVR over time.
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Schenker et al. (2024) conducted an observational in Aortic valve stenosis (n=19,899). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Annual change in TAVR procedure rates (IRR 1.10, 95% CI 1.08-1.12). Transcatheter aortic valve replacement rates increased annually by 10% (IRR 1.10) while surgical aortic valve replacement rates decreased by 5% across Swiss regions between 2013 and 2018.
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