TY - JOUR
T1 - Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal
T2 - a retrospective analysis from 2015 to 2017
AU - Avelar, FG
AU - Emmerick, Isabel
AU - Alves, Joana
N1 - Funding Information:
The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).
Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/2/6
Y1 - 2023/2/6
N2 - Objectives To identify the factors associated with transcatheter aortic valve implantation (TAVI) use of TAVI in inpatients with aortic stenosis (AS) in Portugal and its geographical distribution. Methods A quantitative, observational and retrospective study using the Portuguese National Health Service inpatient discharge database from 2015 to 2017. Surgical aortic valve replacement (SAVR) and TAVI procedures were selected using the International Classification of Diseases. First, we mapped the yearly age-standardised rate for each procedure using QGIS. Then, we performed χ 2 tests, independent t-tests and logistic regressions to study the factors associated with TAVI use. Results From 2015 to 2017, 8398 hospitalisations were selected, 88.5% SAVR and 11.5% TAVI. From 2015 to 2017, SAVR use increased in the Northern region and decreased in the Lisbon region, while the opposite was observed for TAVI. TAVI was performed among the most complex (p<0.001) and older patients (the mean (SD) age for SAVR was 70 (±11) years old and 81 (±7) years old for TAVI, p<0.001). The results for the logistic regressions showed that, more recent hospitalisations, being older, living in the Lisbon region and having a higher Charlson Comorbidity Index was associated with an increased likelihood of undergoing TAVI (p<0.001). Conclusions TAVI increased over the years. TAVI is more often performed in more severe patients as an alternative to SAVR with similar discharge outcomes. These results suggest the existence of geographic disparities in the availability and access to healthcare services and technologies.
AB - Objectives To identify the factors associated with transcatheter aortic valve implantation (TAVI) use of TAVI in inpatients with aortic stenosis (AS) in Portugal and its geographical distribution. Methods A quantitative, observational and retrospective study using the Portuguese National Health Service inpatient discharge database from 2015 to 2017. Surgical aortic valve replacement (SAVR) and TAVI procedures were selected using the International Classification of Diseases. First, we mapped the yearly age-standardised rate for each procedure using QGIS. Then, we performed χ 2 tests, independent t-tests and logistic regressions to study the factors associated with TAVI use. Results From 2015 to 2017, 8398 hospitalisations were selected, 88.5% SAVR and 11.5% TAVI. From 2015 to 2017, SAVR use increased in the Northern region and decreased in the Lisbon region, while the opposite was observed for TAVI. TAVI was performed among the most complex (p<0.001) and older patients (the mean (SD) age for SAVR was 70 (±11) years old and 81 (±7) years old for TAVI, p<0.001). The results for the logistic regressions showed that, more recent hospitalisations, being older, living in the Lisbon region and having a higher Charlson Comorbidity Index was associated with an increased likelihood of undergoing TAVI (p<0.001). Conclusions TAVI increased over the years. TAVI is more often performed in more severe patients as an alternative to SAVR with similar discharge outcomes. These results suggest the existence of geographic disparities in the availability and access to healthcare services and technologies.
KW - Epidemiology
KW - PUBLIC HEALTH
KW - Valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=85147460803&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-070715
DO - 10.1136/bmjopen-2022-070715
M3 - Article
C2 - 36746542
AN - SCOPUS:85147460803
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 2
M1 - e070715
ER -