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Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018.

Publication ,  Journal Article
Nathan, AS; Yang, L; Yang, N; Khatana, SAM; Dayoub, EJ; Eberly, LA; Vemulapalli, S; Baron, SJ; Cohen, DJ; Desai, ND; Bavaria, JE; Herrmann, HC ...
Published in: Circ Cardiovasc Qual Outcomes
November 2021

BACKGROUND: Despite the benefits of novel therapeutics, inequitable diffusion of new technologies may generate disparities. We examined the growth of transcatheter aortic valve replacement (TAVR) in the United States to understand the characteristics of hospitals that developed TAVR programs and the socioeconomic status of patients these hospitals served. METHODS: We identified fee-for-service Medicare beneficiaries aged 66 years or older who underwent TAVR between January 1, 2012, and December 31, 2018, and hospitals that developed TAVR programs (defined as performing ≥10 TAVRs over the study period). We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between core-based statistical area level markers of socioeconomic status and TAVR rates. RESULTS: Between 2012 and 2018, 583 hospitals developed new TAVR programs, including 572 (98.1%) in metropolitan areas, and 293 (50.3%) in metropolitan areas with preexisting TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated fewer patients with dual eligibility for Medicaid (difference of -2.83% [95% CI, -3.78% to -1.89%], P≤0.01), higher median household incomes (difference $2447 [95% CI, $1348-$3547], P=0.03), and from areas with lower distressed communities index scores (difference -4.02 units [95% CI, -5.43 to -2.61], P≤0.01). After adjusting for the age, clinical comorbidities, race and ethnicity and socioeconomic status, areas with TAVR programs had higher rates of TAVR and TAVR rates per 100 000 Medicare beneficiaries were higher in core-based statistical areas with fewer dual eligible patients, higher median income, and lower distressed communities index scores. CONCLUSIONS: During the initial growth phase of TAVR programs in the United States, hospitals serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

November 2021

Volume

14

Issue

11

Start / End Page

e008260

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Socioeconomic Factors
  • Risk Factors
  • Medicare
  • Humans
  • Hospitals
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis
 

Citation

APA
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ICMJE
MLA
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Nathan, A. S., Yang, L., Yang, N., Khatana, S. A. M., Dayoub, E. J., Eberly, L. A., … Fanaroff, A. C. (2021). Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018. Circ Cardiovasc Qual Outcomes, 14(11), e008260. https://doi.org/10.1161/CIRCOUTCOMES.121.008260
Nathan, Ashwin S., Lin Yang, Nancy Yang, Sameed Ahmed M. Khatana, Elias J. Dayoub, Lauren A. Eberly, Sreekanth Vemulapalli, et al. “Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018.Circ Cardiovasc Qual Outcomes 14, no. 11 (November 2021): e008260. https://doi.org/10.1161/CIRCOUTCOMES.121.008260.
Nathan AS, Yang L, Yang N, Khatana SAM, Dayoub EJ, Eberly LA, et al. Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018. Circ Cardiovasc Qual Outcomes. 2021 Nov;14(11):e008260.
Nathan, Ashwin S., et al. “Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018.Circ Cardiovasc Qual Outcomes, vol. 14, no. 11, Nov. 2021, p. e008260. Pubmed, doi:10.1161/CIRCOUTCOMES.121.008260.
Nathan AS, Yang L, Yang N, Khatana SAM, Dayoub EJ, Eberly LA, Vemulapalli S, Baron SJ, Cohen DJ, Desai ND, Bavaria JE, Herrmann HC, Groeneveld PW, Giri J, Fanaroff AC. Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012-2018. Circ Cardiovasc Qual Outcomes. 2021 Nov;14(11):e008260.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

November 2021

Volume

14

Issue

11

Start / End Page

e008260

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Socioeconomic Factors
  • Risk Factors
  • Medicare
  • Humans
  • Hospitals
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis