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Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study
Xavier Armario1, Jennifer Carron2, Andrew J Simpkin3
1Department of Cardiology, Galway University Hospital, Galway, Ireland; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
The COVID-19 pandemic significantly reduced transcatheter aortic valve replacement (TAVR) procedures globally during its first two waves. Reductions were most pronounced in Africa, Central-South America, and Asia, influenced by socioeconomic factors and public health responses.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic disrupted global healthcare systems, impacting essential medical procedures.
- Patients requiring transcatheter aortic valve replacement (TAVR) faced significant risks of treatment delays.
Purpose of the Study:
- To assess the global impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity.
- To identify factors associated with changes in TAVR procedural volumes during the pandemic.
Main Methods:
- An international registry collected monthly TAVR case volumes from January 2018 to December 2021.
- Data included hospital characteristics (public/private, urban/rural, volume) and country-level factors (socioeconomic status, COVID-19 incidence, public health responses).
Main Results:
- Global TAVR activity decreased by 15% and 7% during the first and second pandemic waves, respectively.
- Significant reductions were observed in Africa (-52%), Central-South America (-33%), and Asia (-29%).
- Greater reductions occurred in private hospitals, urban areas, low-volume centers, less developed countries, and regions with higher COVID-19 incidence and stricter public health measures.
Conclusions:
- Transcatheter aortic valve replacement (TAVR) procedural volumes substantially declined during the initial COVID-19 waves, particularly in Africa, Central-South America, and Asia.
- National socioeconomic status, COVID-19 incidence, and public health interventions influenced TAVR activity.
- Findings offer insights for public health policy during future global health crises.
Background:
The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays.
Objectives:
This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity.
Methods:
This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses.
Results:
We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (-52%; P = 0.001), Central-South America (-33%; P < 0.001), and Asia (-29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity.
Conclusions:
TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.
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