Wait-times Benchmarks for risk-based prioritization in Transcatheter Aortic Valve Implantation: a simulation study.

Miranda, Rafael N; Austin, Peter C; Fremes, Stephen E; Mamas, Mamas A; Sud, Maneesh K; Naimark, David M J; Wijeysundera, Harindra C

Abstract

Demand for transcatheter aortic valve implantation (TAVI) has increased in the last decade, resulting in prolonged wait-times and undesirable health outcomes in many health systems. Risk-based prioritization and wait-times benchmarks can improve equitable access to patients. We used simulation models to follow-up a synthetic population of 50,000 individuals from referral to completion of TAVI. Based on their risk of adverse events, patients could be classified as "low-", "medium-" and "high-risk", and shorter wait-times were assigned for the higher risk groups. We assessed the impacts of the size and wait-times for each risk group on waitlist mortality, hospitalization and urgent TAVIs. All scenarios had the same resource constraints, allowing us to explore the trade-offs between faster access for prioritized patients and deferred access for non-prioritized groups. Increasing the proportion of patients categorized as high-risk, and providing more rapid access to the higher-risk groups achieved the greatest reductions in mortality, hospitalizations and urgent TAVIs (relative reductions of up to 29%, 23% and 38%, respectively). However, this occurs at the expense of excessive wait-times in the non-prioritized low-risk group (up to 25 weeks). We propose wait-times of up to 3 weeks for high-risk patients and 7 weeks for medium-risk patients. Prioritizing higher-risk patients with faster access leads to better health outcomes, however this also results in unacceptably long wait-times for the non-prioritized groups in settings with limited capacity. Decision-makers must be aware of these implications when developing and implementing waitlist prioritization strategies. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.]

Citation

Miranda, R. N., Austin, P. C., Fremes, S. E., Mamas, M. A., Sud, M. K., Naimark, D. M. J., & Wijeysundera, H. C. (in press). Wait-times Benchmarks for risk-based prioritization in Transcatheter Aortic Valve Implantation: a simulation study. European Heart Journal - Quality of Care and Clinical Outcomes, 1-9. https://doi.org/10.1093/ehjqcco/qcae059

• Journal Article Type: Article
• Acceptance Date: Jul 17, 2024
• Online Publication Date: Jul 19, 2024
• Deposit Date: Aug 6, 2024
• Journal: European heart journal. Quality of care & clinical outcomes
• Print ISSN: 2058-5225
• Electronic ISSN: 2058-1742
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: qcae059
• Pages: 1-9
• DOI: https://doi.org/10.1093/ehjqcco/qcae059
• Keywords: Wait-times, Waitlist, Health policy, Transcatheter aortic valve implantation, TAVI
• Public URL: https://keele-repository.worktribe.com/output/881785
• Publisher URL: https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcae059/7717368