Wait-times benchmarks for risk-based prioritization in transcatheter aortic valve implantation: a simulation study

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Medical Simulation

Background:

• Increasing demand for transcatheter aortic valve implantation (TAVI) has led to extended wait times and adverse patient outcomes.
• Risk-based prioritization and wait-time benchmarks are crucial for equitable access to TAVI.

Purpose of the Study:

• To evaluate the impact of risk-based prioritization strategies on patient outcomes and wait times for transcatheter aortic valve implantation (TAVI).
• To determine optimal wait-time benchmarks for different risk groups undergoing TAVI.

Main Methods:

• Utilized simulation models to analyze a synthetic population of 50,000 individuals undergoing TAVI.
• Classified patients into low-, medium-, and high-risk groups, assigning shorter wait times to higher-risk categories.
• Assessed the effects of risk group size and wait times on waitlist mortality, hospitalizations, and urgent TAVI procedures under consistent resource constraints.

Main Results:

• Prioritizing high-risk patients with shorter wait times significantly reduced mortality (up to 29%), hospitalizations (up to 23%), and urgent TAVIs (up to 38%).
• This prioritization led to extended wait times (up to 25 weeks) for non-prioritized, low-risk patients.
• Proposed wait times: up to 3 weeks for high-risk and 7 weeks for medium-risk patients.

Conclusions:

• Faster access for higher-risk patients improves overall health outcomes but can create unacceptably long wait times for lower-risk groups in resource-limited settings.
• Healthcare decision-makers must carefully consider these trade-offs when implementing TAVI waitlist prioritization strategies.