Have we Made Progress in Ensuring Equitable Penetration of TAVR Among Diverse Patient Populations? If not, Why?
摘要
The prevalence of aortic stenosis (AS) is increasing as the population ages, particularly among adults over 65 years old [1]. Despite advances in the treatment of severe AS, including transcatheter aortic valve replacement (TAVR), disparities in diagnosis, referral, and treatment persist across sex, racial, and socioeconomic groups. This review summarizes the current evidence regarding disparities in valvular heart disease (VHD) diagnosis and AS treatment, highlights barriers that contribute to inequitable access to valve replacement therapies and examines the potential of system-level interventions to improve equity in care delivery.
Recent FindingsPersistent disparities in AS care have been documented across multiple stages of the care pathway, including disease recognition, specialist referral, and receipt of aortic valve replacement (AVR). We present findings from a pragmatic randomized quality improvement intervention evaluating electronic provider notifications (EPNs) designed to improve recognition and treatment of severe AS. In a cluster-randomized trial, EPNs significantly increased rates of AVR, improved survival among symptomatic patients, and eliminated observed sex-based disparities within this study [2].
SummaryDespite the availability of effective therapies for severe AS, including TAVR, inequities in diagnosis and treatment remain substantial. Findings from the EPN trial suggest that system-level interventions integrated into routine clinical workflows may represent scalable strategies for improving both quality and equity in the delivery of life-saving therapies for severe AS [2].