# Impact of pre-procedural requirements on time to aortic valve replacement: Transcatheter AVR vs surgical AVR

## TL;DR

The study finds that TAVR patients face longer delays due to more specialist visits and imaging, which could be reduced to improve care for high-risk patients.

## Contribution

Quantifies the impact of pre-procedural requirements on TAVR vs SAVR delays using real-world data.

## Key findings

- TAVR patients had nearly twice as many specialist visits and imaging events as SAVR patients.
- Pre-procedural requirements account for 83% of the delay difference between TAVR and SAVR.
- Simplifying TAVR requirements could reduce delays and improve outcomes for high-risk patients.

## Abstract

This study aims to understand the extent that cardiac specialist visits and imaging requirements contribute to the difference in time to Aortic valve replacement (AVR) stratified by approach transcatheter AVR (TAVR) and surgical AVR (SAVR).

Optum Market Clarity Data was used to identify patients with clinically significant AS (CSAS) who received an AVR between 2016 and 2023 and whose AVR occurred within two years of their CSAS diagnosis. Patient characteristics were measured at baseline; pre-procedural factors, including the number of cardiac specialist visits and imaging events, were measured from CSAS diagnosis to AVR (TAVR vs SAVR). Stepwise generalized linear models were used to assess whether the number of cardiac specialist visits and imaging events contribute to the differences in time to TAVR and SAVR, after adjusting for baseline characteristics.

Of the 14,225 patients in the cohort, 42 % received a TAVR. Compared to the SAVR cohort, the TAVR cohort was, on average, more male, older, sicker, and had more Medicare enrollees. TAVR patients had approximately two times more cardiac specialist visits (3.73 vs 6.37) and imaging events (1.18 vs 2.07) than SAVR patients. Time to TAVR is 65 days longer (RR = 1.77, 1.67–1.87) than SAVR, after adjustment for patient characteristics. This difference reduces to 11 days (RR = 1.12, 1.07–1.17) after accounting cardiac specialist encounters and imaging events.

Pre-procedural encounters significantly contribute to the longer time to AVR for TAVR patients. Findings suggest a need for streamlining the pre-procedural process for TAVR to enhance timely care delivery for CSAS patients.

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•TAVR patients waited approximately 59 days longer than SAVR (157 vs 98), risking outcomes for older, high-risk patients.•TAVR patients underwent nearly twice as many cardiac specialist visits and imaging procedures compared to SAVR patients. These additional pre-procedural requirements account for 83% of the delay difference between treatment approaches.•The significantly longer time to TAVR versus SAVR was consistent across age, sex, race, region, and payer groups.•Simplifying requirements for routine TAVR procedures could reduce treatment delays, potentially improving patient outcomes.

TAVR patients waited approximately 59 days longer than SAVR (157 vs 98), risking outcomes for older, high-risk patients.

TAVR patients underwent nearly twice as many cardiac specialist visits and imaging procedures compared to SAVR patients. These additional pre-procedural requirements account for 83% of the delay difference between treatment approaches.

The significantly longer time to TAVR versus SAVR was consistent across age, sex, race, region, and payer groups.

Simplifying requirements for routine TAVR procedures could reduce treatment delays, potentially improving patient outcomes.