Dive Brief:

• The rise of transcatheter procedures has driven a 60% increase in aortic valve replacement in older adults, according to an analysis of Medicare claims data published in the Journal of the American College of Cardiology.
• From 2012 to 2019, use of transcatheter aortic valve replacement grew quickly, overtaking the traditional surgical procedure around the time use was expanded to include intermediate-risk patients in 2016. The trend resulted in more patients receiving aortic valve replacements overall.
• An accompanying editorial identified the analysis of years in which TAVR spread to lower-risk patients and the assessment of overall levels of AVR as the main contributions of the paper. 

Dive Insight:

The authors of the study sought to understand the trends in characteristics and outcomes of patients undergoing AVR by looking at Medicare beneficiaries who had aortic valves replaced from 2012 to 2019. The period covers the big changes in the population eligible for TAVR, which went from being cleared for prohibitive surgical risk patients in 2011 to okayed for use in low-risk patients in 2019.

In Medicare beneficiaries, TAVR case volumes increased by 680% from 2012 to 2019, turning the field into a key growth opportunity and battleground for Edwards Lifesciences and Medtronic. SAVR case volumes fell 40% over the same period.

The overall effect on AVR volumes was positive. With the rise of TAVR more than offsetting the fall in SAVR, the volume of all types of aortic valve replacement rose 60% over the analyzed period.  

Outcomes improved as the AVR market changed, with the one-year mortality for all types of aortic valve replacement falling from 11.9% to 9.4%. The mortality rate fell in TAVR and SAVR, although the bigger decline was seen in the transcatheter cohort. 

The analysis has limitations linked to the nature of the underlying data. As the authors of the editorial note, the Medicare data excludes the "substantial number" of patients aged under 65 years who undergo AVR and fee-for-service claims "do not adequately reflect the growing population of Medicare Advantage beneficiaries." With AVR facing "complex disparities, implementation and quality issues," the authors want to see work to improve data on the procedure. 

"It is time that cardiologists and cardiac surgeons, and their respective professional societies, link the existing STS Adult Cardiac Surgery database and the Transcatheter Valve Therapies Registry, along with administrative claims data," the authors wrote. "Such a resource would facilitate needed pragmatic, prospective studies and retrospective research to answer pressing implementation and health policy questions specific to this new, mature phase of AVR care in the United States."

The study comes a week after an analysis of Medicare claims data published in JAMA Cardiology found that Black, Hispanic and socioeconomically disadvantaged patients have lower rates of TAVR than affluent White populations in 25 U.S. metropolitan areas.