Inequality in access to TAVI
Aims
TAVI (trans-catheter aortic valve implantation) offers an alternative to surgical valve replacement and has been implanted in many octogenarians and older patients. Our aim is to review the differences in access to TAVI between Different States, public vs private sectors and high, intermediate and low society of thoracic surgeon (STS) scores in Australia.
Methods
Retrospective patient data from the Australian Cardiac Outcomes Registry(ACOR) between 2018-2023 were analysed. Descriptive statistics were used to analyse data initially. Then we used Chi squared statistic to ascertain differences between states.
Results
There were a total of 16207 TAVI’s. Median age of procedure was 81.6 years. Median STS was 5. These were performed at 52 hospitals with 95% of patients being between 70-99 years. 8 patients were centenarians. New South Wales(NSW) had performed the highest number of TAVI’s (4922). The majority of cases (67%) were PVT. Of these 70-75% of cases in NSW, Queensland and Western Australia have been performed in the PVT. All cases in TAS were PUB. There were significant defences between the proportion of PUB vs PVT procedures in all states (Chi square 709.9, P<0.05). There was a minimal numerical difference in the STS score between the PUB vs PVT. Majority(58%) of the patient were metropolitan. There was a significant difference between the proportion of metropolitan vs nonmetropolitan patients when comparing states(Chi squared 524.73 p<0.05).
Conclusion
More resource allocation needs to be considered to bridge the metropolitan-rural gap as well as the PUB-PVT gap.