Key result
Delaying TAVR >90 days is linked to a ~198% increase in mortality among veterans.
Why the study?
Logistic and resource-related healthcare system challenges cause delays in TAVR, but the impact of delays in diagnosis, referral, workup, and treatment on survival and heart failure hospitalizations in the Veterans Affairs Health System was unknown.
Cohort (n=233)
No
Hazard Ratio: 2.98
p-value: p=0.04
Delays >90 days may worsen outcomes in severe AS; leaves open whether expediting pathways improves survival.
BACKGROUND Transcatheter aortic valve replacement (TAVR) improves survival and quality of life for patients with aortic valve stenosis. Despite these benefits, logistic and resource-related challenges within healthcare systems lead to delays in intervention. This study evaluates the impact of delays in diagnosis, referral, workup and treatment on survival and heart failure hospitalizations in the Veterans Affairs (VA) Health System. METHODS This retrospective cohort study of veterans who underwent TAVR at the VA Puget Sound (PUG) from 1/1/2019-8/31/2024. Data includes demographics, comorbidities, referral (inpatient vs. outpatient), and times from initial diagnosis to TAVR. Survival was compared by wait-times and patient presentation, and a multivariate analysis was used to identify independent predictors of mortality, adjusting for age, comorbidities, and referral status. RESULTS We analyzed 233 veterans, 154 (66%) outpatients, and 79 (34%) inpatients. Outpatients had a median wait time from diagnosis to treatment of 121 days [IQR 85-198], and inpatients 43 days [IQR 11-119]. Independent predictors of mortality included diagnosis to treatment >90 days (HR 2.98, p=0.04), Stage 3+ renal insufficiency (HR 2.46, p=0.02), chronic lung disease (HR 2.66, p=0.02), and NYHA Class (HR 2.12, p=0.01). STS Risk, rural location, distance from the VA and Social Vulnerability Index were not significantly associated with mortality after adjustment suggesting that mortality suggesting impact from system delays were more significant than patient-specific access barriers. CONCLUSIONS Delays from diagnosis to TAVR among outpatients >90 days were associated with increased mortality. Patients whose initial diagnosis was made during a heart failure hospitalization had worse outcomes. These findings highlight the need for expediting referrals and reducing wait-times, which will potentially lead to substantial improvements in survival for patients with severe symptomatic aortic valve stenosis.
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Greydanus et al. (2026) conducted a cohort in aortic valve stenosis (n=233). Diagnosis to treatment delay >90 days vs. Diagnosis to treatment delay ≤90 days was evaluated on mortality (HR 2.98, p=0.04). A delay from diagnosis to TAVR of >90 days was associated with increased mortality (HR 2.98, p=0.04) among veterans.
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