Urban, regional and remote outcomes following TAVR for Queensland patients: a retrospective cohort study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Transcatheter aortic valve replacement (TAVR) offers a minimally invasive approach to treat severe aortic stenosis (AS) but can only be performed at centres meeting strict regulatory requirements. It remains unclear whether this requirement restricts TAVR access for patients residing in rural Australia, and whether such people experience poorer outcomes than metropolitan counterparts as a result. Methods This multicentre retrospective cohort study used Australian Cardiac Outcomes Registry data. All Queensland residents who underwent TAVR between April 2018 and 27 March 2026 were included. Rurality was assigned by postcode using the Modified Monash Model (MMM) and grouped as urban (MMM1), regional (MMM2–4), or remote (MMM5–7). The primary outcome was 12-month mortality and was investigated using Kaplan-Meier and Cox proportional hazards analyses. Findings Among 6813 patients, 4246 (62%) were urban, 2092 (31%) regional, and 475 (7%) remote. Twelve-month all-cause mortality did not differ by rurality (urban: 211 [5.0%]; regional: 103 [4.9%]; remote: 23 [4.8%]; χ²=0.991, log-rank P=0.929), a finding confirmed in multivariable analysis. At the time of TAVR, regional and remote patients were younger, more comorbid, had more severe AS, and lower STS scores than urban counterparts. Clinical frailty score, non-transfemoral access, STS score, atrial fibrillation or flutter, and moderate–severe chronic lung disease independently predicted 12-month mortality. Interpretation TAVR outcomes were comparable between rurality groups, suggesting equitable care within Queensland’s centralised TAVR model. However, registry data only captures patients who underwent TAVR and may miss older rural patients facing barriers to AS diagnosis, referral, or procedural workup. Funding There was no funding or sponsor involvement. Research in context Evidence before this study We searched Medline (Ovid) for publications examining the association between rurality and outcomes after transcatheter aortic valve replacement (TAVR). We searched from database inception to September 2026 using the terms “TAVR” OR “transcatheter aortic valve replacement” OR “transcatheter aortic valve implantation” OR “TAVI”, AND “rural*”. We identified two key studies of rurality and TAVR outcomes, one from the USA and one from Australia. Both reported no difference in mortality between rural and urban patients. However, both were single-centre studies with small samples (413 and 142 patients, respectively) and neither used time-to-event analysis. The US study followed patients for only 6 months and used descriptive analysis alone. The Australian study included urban and regional patients but not remote patients. Added value of this study In 6813 patients from a national procedural registry, 12-month all-cause mortality after TAVR did not differ between urban, regional, and remote Queensland residents (5.0%, 4.9%, and 4.8%, respectively), including after multivariable adjustment and in sensitivity analyses. This was despite regional and remote patients being younger, having more comorbidity, lower STS scores, and having more severe AS at the time of the procedure. To our knowledge, this is the largest study of TAVR outcomes by rurality and the first in Australia to include remote patients. Remote residents and First Nations people were underrepresented among TAVR recipients compared with the Queensland population. Implications of all the available evidence Among people who reach TAVR, a centralised delivery model appears to provide comparable short-term outcomes regardless of where patients live. However, ACOR data only captures patients who received the procedure, and the younger age of rural patients and underrepresentation of remote patients suggests that barriers may exist earlier in the pathway, at diagnosis, referral, or work-up. Future research linking diagnostic and referral data to procedural data is needed to assess access, and the findings should inform planning of non-metropolitan AS services.
Source: medRxiv
Institution: James Cook University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223676664