Training/Practice
Health Policy and Promotion
The Transcatheter Aortic Valve Implantation (TAVI) Quality Report: A Call to Arms for Improving Quality in Canada

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Abstract

Transcatheter aortic valve implantation (TAVI) is a disruptive technology that has dramatically changed the way clinicians care for patients with aortic stenosis. In 15 short years, this technology has progressed from first-in-human to the standard of care for high-risk and inoperable patients with aortic stenosis. In 2016 the Canadian Cardiovascular Society published the first ever report of quality of care for TAVI in Canada. This report provided multiple insights into evaluating such care delivered to Canadians and the challenges that lie ahead. In this article, we summarize these challenges and encourage cardiologists to join the call to arms for improving quality of TAVI care in Canada.

Résumé

Le remplacement valvulaire aortique par cathéter (TAVI) est une technologie perturbatrice qui a changé considérablement la manière dont les cliniciens soignent les patients atteints d'une sténose aortique. En seulement 15 ans, cette technologie est passée de la première implantation humaine à la norme de soins chez les patients atteints d'une sténose aortique qui sont exposés à un risque élevé et qui sont inopérables. En 2016, la Société canadienne de cardiologie a publié le tout premier rapport sur la qualité des soins liés au TAVI au Canada. Le présent rapport a donné de nombreux aperçus sur l’évaluation de ces soins offerts aux Canadiens et sur les enjeux qui se profilent à l’horizon. Dans cet article, nous faisons la synthèse de ces enjeux et nous incitons les cardiologues à participer à l’amélioration de la qualité des soins liés au TAVI au Canada.

Section snippets

TAVI Procedures in Canada

Data obtained for the quality report spanned from April 2013 to March 2014. During that time period, 1122 patients were treated with TAVI for a national rate of 34 procedures per million inhabitants. There was considerable interprovincial variation in procedural volumes reflecting a disparity in access to care across the country, with 2 provinces having no local program (Saskatchewan and Newfoundland) at the time. Compared with other developed countries, in 2013 the rates of TAVI in Canada fell

TAVI Quality Indicators

The TAVI quality indicators were divided into 3 groups: structure, process, and outcomes (Fig. 1). The structure outcomes evaluated included documentation of: (1) a heart team recommendation for patients treated with TAVI; and (2) wait time for TAVI. A heart team recommendation was used in most centres (87.4%), illustrating appropriate collaboration between cardiology and cardiac surgery for optimal treatment decisions. This consensus is currently the standard of care for patients with aortic

Strengthening the Commitment to Quality

TAVI is increasingly becoming the standard of care for select patients while indications continue to broaden. The first CCS TAVI quality report shows that a national initiative to measure quality in cardiovascular care is feasible and valuable to clinicians, policy makers, and patients. This should serve as a “call to arms” to promote accountability, transparency, and quality assurance to improve the care of people treated with TAVI. We now have a unique opportunity to work collectively and in

Disclosures

The authors have no conflicts of interest to disclose.

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Cited by (13)

  • The Safety of Early Discharge Following Transcatheter Aortic Valve Implantation Among Patients in Northern Ontario and Rural Areas Utilizing the Vancouver 3M TAVI Study Clinical Pathway

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    Despite the rise in the total number of TAVI procedures in Canada, the increase is not meeting the significant growth in demand due to the aging population and the expansion of TAVI indications to lower-risk populations.6 This problem is further compounded for patients that reside in rural areas, due to the inequity in access to TAVI that exists within Canada.6 Northern Ontario is an example of this, where issues exist pertaining to resource availability, program capacity, and limited TAVI funding allocation compared to centres in southern Ontario.

  • Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a “Real World” Population: Insights From a Prospective Canadian Database

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    There remains a significant gap between the consensus agreement that PROMs matter, and the availability of efficient and patient-centred electronic systems to collect, analyze, and report PROMs data in a timely and effective way.43 Overcoming these barriers with solutions tailored to the needs of the primarily older aortic stenosis population remains a challenge across Canadian jurisdictions.4 Our study should be interpreted in light of several limitations.

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