Key result
Socioeconomic disadvantage linked to ~42% lower odds of receiving TAVI versus SAVR.
Why the study?
Despite increasing TAVI activity in Australia, patient access to TAVI remains limited and more complex than access to SAVR, prompting an investigation into the socioeconomic factors associated with receiving TAVI versus SAVR in New South Wales.
Does socioeconomic status and funding type affect the likelihood of receiving transcatheter aortic valve implantation versus surgical aortic valve replacement in older patients in New South Wales, Australia?
Observational (n=6,493)
Yes
Does socioeconomic status and funding type affect the likelihood of receiving transcatheter aortic valve implantation versus surgical aortic valve replacement in older patients in New South Wales, Australia?
In New South Wales, Australia, access to TAVI versus SAVR varies significantly by socioeconomic status and health insurance funding type, highlighting disparities that require policy attention to ensure equitable access based on clinical need.
Answers are grounded in this paper and cite their sources.
May reflect access inequities warranting clinician awareness; leaves open targeted equity interventions in valvular procedures.
BACKGROUND: Despite increasing transcatheter aortic valve implantation (TAVI) activity in Australia in recent years, patient access to TAVI remains limited and is often more complex than access to surgical aortic valve replacement (SAVR). The aim of this study was to identify socioeconomic factors associated with the likelihood of receiving TAVI versus SAVR in New South Wales (NSW), Australia. METHODS: Data from the NSW Admitted Patient Data Collection were used to compare the clinical and socioeconomic profiles of patients aged ≥65 years who underwent either TAVI or SAVR between 1 November 2017 and 28 February 2022. Multiple logistic regression analyses were performed on the overall patient cohort and on subgroups defined by age groups, hospital type and funding type. RESULTS: The study included 6,493 patients (mean age: 79.1 years, 35.5% female) who underwent aortic valve replacement (SAVR=3,294; TAVI=3,199). The odds of receiving TAVI versus SAVR increased significantly with age (adjusted odds ratio [aOR] for patients aged 85 years and older versus those aged 75-84 years: 12.3, 95% CI: 9.99-15.2). Patients from the most disadvantaged socioeconomic areas had lower odds of receiving TAVI than those from the least disadvantaged areas (aOR:0.58, 95% CI: 0.47-0.73). Patients with private health insurance/Department of Veterans Affairs (PHI/DVA) funding were more likely to receive TAVI than SAVR (aOR: 3.29, 95% CI: 2.61-4.14), with this finding consistent across age groups and even more pronounced in patients treated in public hospitals (aOR: 5.82, 95% CI: 4.40-7.70). CONCLUSIONS: Our study highlights significant variations in TAVI access based on age, socioeconomic status of area of residence, and funding type. These findings underscore the need for policy settings that promote equitable access and ensure that procedural choices for aortic valve replacement reflect clinical needs.
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Shawon et al. (2026) conducted an observational in Aortic valve disease requiring aortic valve replacement (n=6,493). Most disadvantaged socioeconomic area residence vs. Least disadvantaged socioeconomic area residence was evaluated on Likelihood of receiving TAVI versus SAVR (aOR 0.58, 95% CI 0.47-0.73). Socioeconomic disadvantage lowered the odds of receiving TAVI versus SAVR (aOR 0.58, 95% CI 0.47-0.73), while private/veterans funding increased TAVI likelihood (aOR 3.29, 95% CI 2.61-4.14).
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