Regional variation and temporal trends in transcatheter and surgical aortic valve replacement in Switzerland: A population-based small area analysis

• Published in: PloS one 2024-01, Vol.19 (1), p.e0296055-e0296055
• Main Authors: Schenker, Carla, Wertli, Maria M, Räber, Lorenz, Haynes, Alan G, Chiolero, Arnaud, Rodondi, Nicolas, Panczak, Radoslaw, Aujesky, Drahomir
• Format: Article
• Language: English
• Subjects: Age; Analysis; Aorta; Aortic valve; Asymptomatic; Biology and Life Sciences; Cardiology; Cardiovascular diseases; Care and treatment; Complications and side effects; Demographics; Demography; Diagnosis; Disease; France; Geographical variations; Health insurance; Heart diseases; Heart valve diseases; Heart valve replacement; Heart valves; Hospitals; Insurance; Insurance coverage; Medicine and Health Sciences; Mortality; Patient outcomes; Patients; People and Places; Population density; Regions; Reimbursement; Rheumatic heart disease; Service areas; Sex; Social Sciences; Socioeconomic factors; Socioeconomic status; Socioeconomics; Stenosis; Surgeons; Trends
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0296055

Aortic valve stenosis (AS) is the most common valvular heart disease and if severe, is treated with either transcatheter (TAVR) or surgical aortic valve replacement (SAVR). We assessed temporal trends and regional variation of these interventions in Switzerland and examined potential determinants of geographic variation. We conducted a population-based analysis using patient discharge data from all Swiss public and private acute care hospitals from 2013 to 2018. We generated hospital service areas (HSAs) based on patient flows for TAVR. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). Using multilevel regression, we calculated the influence of calendar year and regional demographics, socioeconomic factors (language, insurance status), burden of disease, and number of cardiologists/cardiovascular surgeons on geographic variation. Overall, 8074 TAVR and 11,825 SAVR procedures were performed in 8 HSAs from 2013 to 2018. Whereas the age-/sex-standardized rate of TAVR increased from 12 to 22 procedures/100,000 persons, the SAVR rate decreased from 33 to 24 procedures during this period. After full adjustment, the predicted TAVR and SAVR rates varied from 12 to 22 and 20 to 35 per 100,000 persons across HSAs, respectively. The regional procedure variation was low to moderate over time, with a low overall variation in TAVR (EQ 1.9, SCV 3.9) and SAVR (EQ 1.6, SCV 2.2). In multilevel regression, TAVR rates increased annually by 10% and SAVR rates decreased by 5%. Determinants of higher TAVR rates were older age, male sex, living in a German speaking area, and higher burden of disease. A higher proportion of (semi)private insurance was also associated with higher TAVR and lower SAVR rates. After full adjustment, 10.6% of the variance in TAVR and 18.4% of the variance in SAVR remained unexplained. Most variance in TAVR and SAVR rates was explained by language region and insurance status. The geographic variation in TAVR and SAVR rates was low to moderate across Swiss regions and largely explained by differences in regional demographics and socioeconomic factors. The use of TAVR increased at the expense of SAVR over time.