Geographic Access to Transcatheter Aortic Valve Replacement Centers in the United States Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

Importance Geographic access to transcatheter aortic replacement (TAVR) centers varies in the United States as a result of controlled expansion through minimum volume requirements. Objective To describe the current geographic access to TAVR centers in the United States. Design, Setting, and Participants Observational study from June 1, 2015, to June 30, 2017. United States census data were used to describe access to TAVR center. Google Maps and the Society of Thoracic Surgeons American College of Cardiology Transcatheter Valve Therapy Registry were used to describe characteristics of patients undergoing successful TAVR according to proximity to implanting center. The study analyzed 47527537 individuals 65 years and older in the United States and 31098 patients who underwent successful transfemoral TAVR, were linked to fee-for-service Medicare, and had a measurable driving time. Main Outcomes and Measures Median driving distance to a TAVR center. Results Among 40 537 zip codes in the United States, 490 (1.2%) contained a TAVR center, and among 305 hospital referral regions (HRR), 234 (76.7%) contained a TAVR center. Of the 31 749 patients who underwent successful transfemoral TAVR and were linked to fee-for-service Medicare, 31 098 had a measurable driving time. Mean (SD) age was 82.4 (6.9) years, 14 697 patients (47.3%) were women, and 7422 (23.87%) lived in a rural area. This translated to 1232568 of 47527537 individuals (2.6%) 65 years and older living in a zip code with a TAVR center and 43789169 (92.1%) living in an HRR with a TAVR center. Among 31749 patients who underwent successful transfemoral TAVR and were linked to fee-for-service Medicare, 31098 had a measurable driving time. All of these patients (100.0%) underwent their procedure in a TAVR center within their HRR, with 1350 (4.3%) undergoing TAVR in a center within their home zip code. Median driving time to implanting TAVR center was 35.0 minutes (IQR, 20.0-70.0 minutes), ranging from 2.0 minutes to 18 hours and 48 minutes. Conclusions and Relevance Most US individuals 65 years and older live in an HRR with a TAVR center. Among patients undergoing successful transfemoral TAVR, median driving time to implanting center was 35.0 minutes. Within the context of the US health care system, where certain advanced procedures and specialized care are centralized, TAVR services have significant penetration. More studies are required to evaluate the effect of geographic location of TAVR sites on access to TAVR procedures among individuals with an indication for a TAVR within the US population. Question What is the geographic access to transcatheter aortic valve replacement (TAVR) centers in the United States? Findings In this observational study, 1232568 of 47527537 individuals 65 years and older lived in a zip code with a TAVR center, and 43789169 (92.1%) lived in a hospital referral region containing a TAVR center. For those who underwent successful TAVR, median driving time to implanting center was 35.0 minutes (interquartile range, 20.0-70.0 minutes). Meaning In the context of the US health care system where specialized care is centralized, TAVR services have significant penetration. This study describes the current geographic access to transcatheter aortic replacement centers in the United States.