Valvular & structural heart diseaseCohort study
Effect of Transcatheter Aortic Valve Replacement Program Ratings on Case Selection
- Retrospective cohort study
- difference-in-difference analysis
Authors' conclusion
Since 2020, there has been a substantial decline in the number of high-risk patients receiving TAVR across the United States, driven predominantly by hospitals that received lower USNWR TAVR ratings.
Study context
- Population
- Medicare fee-for-service beneficiaries undergoing transcatheter aortic valve replacement (TAVR) at USNWR-rated US hospitals618 hospitals
- Exposure
- Lower rated hospitals vs High-performing hospitals
- Outcome
- Patient risk profile (Elixhauser comorbidity score)
Main finding
Elixhauser comorbidity score · after ratings release
Difference-in-difference estimator
−0.48
95% CI −0.66 to −0.31
P < 0.0001
Lower rated vs High-performing
difference-in-difference estimator −0.48 (95% CI −0.66 to −0.31); P < 0.0001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | IRR (95% CI) | P value | |
|---|---|---|---|
| Number of high-risk TAVR cases (Elixhauser score > 20) · after ratings release · all hospitals declined; greater decline at lower rated | 0.56 (0.51–0.62) | P < 0.0001 | |
| 0.512Incidence rate ratio (log scale) |
Original publication
Effect of Transcatheter Aortic Valve Replacement Program Ratings on Case Selection. JACC Cardiovasc Interv. Published 24 November 2025. doi:10.1016/j.jcin.2025.09.022
Summarised from the published abstract; every number is checked against it