Access to transcatheter aortic valve implantation: interregional variability and expert evaluation

ABSTRACT Introduction and objectives: Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe symptomatic aortic stenosis, providing an alternative to surgical valve aortic replacement, especially in high-risk patients. Despite its benefits, significant interregional variability in TAVI access persists within Spain. This study aimed to analyse disparities in TAVI implementation across different autonomous communities, identifying the key factors underlying this variability. Methods: We conducted a retrospective observational study using data from the Spanish National Registry of Specialized Care Activity Minimum Basic Data Set for 2016–2023, including all TAVI performed in Spain. Additionally, a survey was distributed among specialists from 123 centres to assess the factors influencing clinical decision-making, barriers to access, and resource availability. Results: Although the number of TAVI increased across all regions, significant differences were observed in the implantation rates (between 0.63 and 2.28 per 10 000 inhabitants). Survey responses indicated that the primary determinants for TAVI indication were heart team judgment (40.0%) and patient risk stratification (36.5%). The main barriers to expanding TAVI access included rigid patient stratification (25.6%), insufficient early detection (17.8%), and resource limitations (13.3%). Participants emphasized the need for better coordination among health care levels and establishing uniform access criteria. Conclusions: Although TAVI adoption has increased in Spain, significant regional disparities remain, suggesting factors beyond economics contribute to access variability. Addressing these inequalities requires enhanced coordination across different health care levels, optimized resource allocation, and refined patient selection strategies.