Cohort study
Modeling the Association of Volume vs Composite Outcome Thresholds With Outcomes and Access to Transcatheter Aortic Valve Implantation in the US
- Retrospective cohort study (modelling)
- registry-based
- modelled scenarios
Authors' conclusion
In this study, compared with the current system of care, a modeled outcome-based spoke-and-hub paradigm of TAVI care improved national outcomes to a greater extent than a simulated volume threshold, at the cost of increased driving time.
Study context
- Population
- Adults undergoing transcatheter aortic valve implantation (TAVI) in the US STS/ACC Transcatheter Valve Therapy registry; baseline July 2017–June 2020, modelled July 2020–March 2022
- Participants
- 166,248 adults
- Exposure
- Modelled volume threshold vs outcome-based spoke-and-hub vs current care
- Outcome
- Absolute difference in events between adjusted observed and modelled composite of death, stroke, major bleeding, stage III AKI and paravalvular leak
- Follow-up
- 30 days
Main finding
As reported in the abstract
Adverse events reduced (30-day composite)
Number of events reduced
- Volume threshold · no significant reduction
- −34 (95% CrI −75 to 8)
- Best outcome site · fewer adverse outcomes
- 1261 (95% CrI 1013–1500)
Observational data: associations, not effects.
Further findings
Median, minutes
| Outcome | Volume threshold | Best outcome site | Current system of care |
|---|---|---|---|
| Driving time to alternate site | 22 (IQR 15–66) | 23 (IQR 15–41) | Not reported in the abstract |
Black, Hispanic and rural individuals (subgroups)
- Directionally similar findings
Original publication
Modeling the Association of Volume vs Composite Outcome Thresholds With Outcomes and Access to Transcatheter Aortic Valve Implantation in the US. JAMA Cardiol. Published 1 May 2023. doi:10.1001/jamacardio.2023.0477
Summarised from the published abstract; every number is checked against it