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Transcatheter aortic valve implantation for severe aortic stenosis in the Australian regional population

Paleri, S, Tham, JLM, Jin, D, Chan, YS, Wright, C, Baradi, A, Whitbourn, RJ, Adams, HSL and Palmer, SC 2019 , 'Transcatheter aortic valve implantation for severe aortic stenosis in the Australian regional population' , Australian Journal of Rural Health, vol. 27, no. 3 , pp. 229-236 , doi: 10.1111/ajr.12508.

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Abstract

Objective: To compare clinical and functional outcomes of regional and urban pa-tients after transcatheter aortic valve implantation for severe aortic stenosis.Methods: Data were collected at patient follow- up post- transcatheter aortic valve implantation at 30 days and 12 months. Patients were stratified by residential post-codes into remoteness areas using the Australian Statistical Geography Standard.Design: Retrospective cohort study.Setting: Single- centre tertiary referral hospital.Participants: Patients undergoing transcatheter aortic valve implantation (n = 142) from 2009 to 2018 were analysed, with 77 patients (54.2%) residing in regional Victoria and New South Wales.Main outcome measures: Procedural success, adverse event rates, readmission rates, mortality rates, loss to follow- up and functional improvement.Results: Patients residing in regional areas had a lower mean age (81.8 vs 83.7 years) and proportion of Stage 4 or 5 chronic kidney disease (1.3% vs 9.2%), compared with urban patients. Procedural characteristics and immediate post- procedural outcomes were similar between both groups. There was no statistically significant difference in mortality, readmission rates or loss to follow- up between the two cohorts. Regional pa-tients demonstrated poorer rates of functional improvement at 30 days (50.7% vs 67.7%); however, this difference was not sustained at 12 months (79.2% vs 71.0%). Frailty was demonstrated to be an independent predictor of poor 30- day functional improvement.Conclusion: Regional patients treated with transcatheter aortic valve implantation for severe aortic stenosis have non- inferior 30- day and 12- month outcomes, when compared with urban patients. Frailty is a predictor of poor functional improvement post- transcatheter aortic valve implantation.

Item Type: Article
Authors/Creators:Paleri, S and Tham, JLM and Jin, D and Chan, YS and Wright, C and Baradi, A and Whitbourn, RJ and Adams, HSL and Palmer, SC
Keywords: cardiovascular medicine, health systems, models of regional service delivery, rural population health, therapeutics
Journal or Publication Title: Australian Journal of Rural Health
Publisher: Wiley-Blackwell Publishing Asia
ISSN: 1038-5282
DOI / ID Number: 10.1111/ajr.12508
Copyright Information:

© 2019 National Rural Health Alliance Ltd.

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