[State of practice: evolving portrait of the use and clinical outcomes of transcatheter aortic valve implantation (TAVI) in Québec, an evaluation in the real-world context of care, 2013 to 2018]

Azzi L, Boothroyd L, de Verteuil D, Lambert L, Nicolae MV
Record ID 32018000901
French
Original Title: État des pratiques: profil évolutif de l’utilisation et des résultats cliniques de l’implantation valvulaire aortique par cathéter (TAVI) au Québec : évaluation en contexte réel de soins de 2013 à 2018
Authors' objectives: This state of practice gave information between April 1, 2013 and March 31, 2018: the organizational structure of TAVI interventions, the characteristics of the patients treated by TAVI, patient selection processes (including wait times), care processes related to the TAVI intervention and length of stay, major adverse events, and clinical results following the intervention.
Authors' results and conclusions: RESULTS: CLINICAL OUTCOMES - The proportion of patients who returned home at hospital discharge increased from 74% in 2013-2014 to approximately 80% in 2017-2018. During the same time period, there was a decrease in the proportion of patients who died at a TAVI facility (from 6.5% to 1.9%), or who were sent to a long-term care facility (from 5% to 2%). The proportion of patients transferred to another acute care hospital has remained relatively stable over the years (13% in 2013-2014 and 14% in 2017-2018). The incidence of 30-day mortality decreased from 6.5% in 2013-2014 to 2.7% in 2017-2018 (p=0.008), while 1-year mortality decreased by a third, from 14.6% in 2013-2014 to 9.0% in 2017-2018 (p=0.01). WAIT TIMES - Since 2015-2016, the median time for patient assessment (from referral to treatment decision) has been maintained at approximately 60 days and is in line with the Canadian median. The median time from the treatment decision to the actual procedure has decreased since 2015-2016 to 32 days in 2017-2018, which is shorter than the Canadian median delay of 56 days. ORGANIZATIONAL STRUCTURE - The number of TAVIs performed in Québec increased from 294 in 2013-2014 to 526 in 2017-2018, at which time it accounted for 30% of all aortic valve replacements (TAVIs and SAVRs, with or without CABG, combined). The TAVI utilization rate of 49 per million population in 2017-2018 is similar to the Canadian average but is below that observed in Ontario and British Columbia. WAIT TIMES - • Since 2015-2016, the median time for patient assessment (from referral to treatment decision) has been maintained at approximately 60 days and is in line with the Canadian median. The median time from the treatment decision to the actual procedure has decreased since 2015-2016 to 32 days in 2017-2018, which is shorter than the Canadian median delay of 56 days.
Authors' methods: Many of the patients selected for treatment with TAVI in Québec were over 85 years of age and had major comorbidities and suffered symptoms that substantially limited their physical activity (NYHA classes III and IV).
Details
Project Status: Completed
Year Published: 2020
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Heart Valve Prosthesis Implantation
  • Transcatheter Aortic Valve Replacement
  • Aortic Valve Stenosis
  • Data Collection
Keywords
  • Percutaneous valvuloplasty
  • Coarctation of the aorta
Contact
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.