Geographic Patterns of Growth for Transcatheter Aortic Valve Replacement in the United States.
Geographic Patterns of Growth for Transcatheter Aortic Valve Replacement in the United States.
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美国经导管主动脉瓣置换术增长的地理模式。
DOI：
10.1161/circulationaha.119.040788
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发表时间：
2019
期刊：
影响因子：
37.8
通讯作者：
Yeh,RobertW
中科院分区：
文献类型：
--
作者：
Kundi,Harun;Faridi,KamilF;Wang,Yun;Wadhera,RishiK;Valsdottir,LindaR;Popma,JeffreyJ;Kramer,DanielB;Yeh,RobertW
尽管观察到的TAVR增长的地理差异可能反映了区域实践模式或患者病例组合的差异，但它们也可能反映了新的和潜在的救生治疗的可用性和可获得性的差异。此前曾观察到血管造影和经皮冠状动脉介入治疗心脏手术的地理可用性存在差异，但没有改善进入服务最少地区的机会。4监管机构评估开始和维持TAVR项目的严格体积要求时，需要平衡有利手术结局和所有合格主动脉瓣狭窄患者合理入路的目标。之前，我们证明了给定医院的历史SAVR结局可预测TAVR的后续结局，并且可以被视为除手术量外的额外质量指标。[5]然而，SAVR或TAVR过于繁重的数量基准可能会产生负面影响，传播医疗保健可及性方面根深蒂固的差异。本研究中使用的变量取自行政索赔，可能会受到编码不准确的影响。此外，在TAVR扩展至中、低风险患者之前，接受治疗的人群有限，对新项目的要求也很严格。因此，我们的研究结果可能不能准确地代表第二波的扩展与中，低风险患者。
Although the observed geographic differences in TAVR growth may reflect differences in regional practice patterns or patient case mix, they may also reflect the differential availability and access to a new and potentially lifesaving therapy. Differential geographic availability of cardiac procedures has previously been observed for angiography and percutaneous coronary intervention without improving access to the leastserviced areas. 4 Regulators evaluating strict volume requirements to begin and maintain TAVR programs will need to balance the goals of favorable procedural outcomes and reasonable access for all eligible patients with aortic stenosis. Previously, we demonstrated that historical SAVR outcomes at a given hospital predict subsequent outcomes of TAVR and could be considered an additional measure of quality, in addition to procedural volume. 5 However, overly burdensome volume benchmarks for either SAVR or TAVR may have the regressive effect of propagating entrenched disparities in healthcare access.This analysis is limited by the inclusion of only Medicare fee-for-service beneficiaries. Variables used in this study were taken from administrative claims and may be subject to inaccuracies in coding. In addition, the population being treated was limited before the expansion of TAVR to intermediate-and low-risk patients, with restrictive requirements for new programs. Thus, our findings may not accurately represent the second wave of expansion with intermediate-and lowrisk patients.