Inequity in Access to Transcatheter Aortic Valve Replacement: A Pan-Canadian Evaluation of Wait-Times
| Autor: | Josep Rodés-Cabau, Harindra C. Wijeysundera, Kendra MacFarlane, Rodney Zimmermann, Sandra Lauck, V. Paddock, David A. Wood, Peter C. Austin, Dennis T. Ko, Nicolo Piazza, Graham Woodward, Garth H. Oakes, Malek Kass, Kayley A. Henning, Robert C. Welsh, Syed Najaf Nadeem, Faisal Al Qoofi, Sam Radhakrishnan, Stephen E. Fremes, Olga Toleva, Anita W. Asgar, Mark D. Peterson, Corey Adams, Eric A. Cohen, Brian J. Potter, Feng Qiu, John G. Webb, Marc P. Pelletier, Laurie J. Lambert, Kevin R. Bainey, Benoit Daneault |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Canada Waiting Lists Transcatheter aortic Referral medicine.medical_treatment Population 030204 cardiovascular system & hematology Health Services Accessibility Time-to-Treatment Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Risk Factors medicine Humans Registries 030212 general & internal medicine Healthcare Disparities education Aged Health Services Needs and Demand education.field_of_study Proportional hazards model business.industry Hazard ratio Aortic Valve Stenosis Random effects model Aortic Valve Female Dependant Cardiology and Cardiovascular Medicine business Demography |
| Zdroj: | Canadian Journal of Cardiology. 36:844-851 |
| ISSN: | 0828-282X |
| Popis: | Background There has been an exponential increase in the demand for transcatheter aortic valve replacement (TAVR). Our goal was to examine trends in TAVR capacity and wait-times across Canada. Methods All TAVR cases were identified from April 1, 2014, to March 31, 2017. Wait-time was defined as the duration in days from the initial referral to the TAVR procedure. TAVR capacity was defined as the number of TAVR procedures per million population/province/fiscal year. We performed multivariable multilevel Cox proportional hazards modelling of the time to TAVR as the dependant variable and the effect of provinces as random effects. We quantified the variation in wait-times among provinces using the median hazard ratio. Results We identified a total of 4906 TAVR procedures across 9 provinces. Despite a year over year increase in overall capacity, there was a greater than 3-fold difference in capacity between provinces. Crude median wait-times increased over time in all provinces, with marked variation from 71.5 days in Newfoundland to 190.5 and 203 days in Manitoba and Alberta, respectively. This suggests increasing demand outpaced the growth in capacity. We found a median hazard ratio of 1.62, indicating that in half of the possible pairwise comparisons, the time to TAVR for identical patients was at least 62% longer between different provinces. Conclusion We found substantial geographic inequity in TAVR access. This calls for policy makers, clinicians, and administrators across Canada to address this inequity through revaluation of provincial funding mechanisms, as well as implementation of efficient care pathways. |
| Databáze: | OpenAIRE |
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