Differences in life expectancy within and between countries: implications for domestic TAVI guidelines in Australia and Aotearoa New Zealand

Thomas D Ryan ¹, Jonathon B Ryan ²

⁰Graduate Medical Student, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

The New Zealand Medical Journal +

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April 11, 2024

View abstract on PubMed

Summary

Transcatheter aortic valve implantation (TAVI) offers an alternative to surgical aortic valve replacement (SAVR), but long-term durability is uncertain. This study proposes sex-specific, age-based recommendations for TAVI versus SAVR in Australia and New Zealand, considering diverse populations.

Area Of Science

Cardiovascular Medicine
Interventional Cardiology
Public Health

Background

Transcatheter aortic valve implantation (TAVI) is increasingly used for aortic stenosis, challenging traditional surgical aortic valve replacement (SAVR).
Long-term durability of TAVI valves, particularly beyond 10 years, remains a significant concern, especially for younger patients.
Current guidelines lack specific recommendations for TAVI versus SAVR based on long-term outcomes and diverse demographic groups.

Purpose Of The Study

To develop sex-specific, age-based recommendations for choosing between TAVI and SAVR.
To inform clinical decision-making for aortic stenosis management in Australia and Aotearoa New Zealand.
To address the needs of specific populations, including Aboriginal and Torres Strait Islander peoples, Māori, and Pacific peoples.

Main Methods

Collation and analysis of life expectancy data from Australia and Aotearoa New Zealand.
Development of a framework for sex-specific and age-based treatment recommendations.
Consideration of ethnic and cultural factors in treatment choices.

Main Results

Life expectancy data suggests potential differences in optimal treatment strategies based on sex and age.
Recommendations are tailored to the general populations of Australia and Aotearoa New Zealand.
Specific considerations are proposed for Aboriginal and Torres Strait Islander people, Māori, and Pacific peoples.

Conclusions

Sex-specific, age-based recommendations can optimize the choice between TAVI and SAVR for aortic stenosis.
These recommendations aim to improve long-term outcomes by considering patient longevity and specific population needs.
Further research is warranted to validate these recommendations and assess long-term TAVI valve performance across diverse groups.