The Clinical and Economic Consequences of Delayed Transcatheter Aortic Valve Replacement

Delays in access to aortic valve replacement, the recommended treatment for aortic stenosis (AS), is common; however, the impact of this delay is not clearly known. This study aims to examine the clinical and economic consequences of delayed transcatheter aortic valve replacement (TAVR) in patients with clinically significant AS. We analyzed 4069 patients with clinically significant AS who underwent TAVR between July 2019 and June 2023 using the Optum Market Clarity database. Patients were categorized as timely TAVR (≤90 days from diagnosis) or delayed TAVR (>90 days or urgent/emergent procedure). Clinical outcomes included all-cause mortality, heart failure hospitalizations, stroke, and composite endpoints over 3 years. Economic outcomes included total health care costs and hospitalization utilization. Multivariable Cox proportional hazards and generalized linear models were used for analysis. Of 4069 patients, 2051 (50.4%) received timely TAVR and 2018 (49.6%) received delayed TAVR. Delayed patients had higher frailty scores (10.9 vs. 8.5; p < 0.01) but similar comorbidity burden. At 3 years, delayed TAVR was associated with significantly higher composite outcomes (50.1 vs. 36.8%; hazard ratio (HR): 1.52; p < 0.01), mortality (19.5 vs. 13.7%; HR: 1.50; p < 0.01), and heart failure hospitalizations (38.4 vs. 26.5%; HR: 1.59; p < 0.01). Disabling stroke was not statistically significant (10.0 vs. 7.9%; HR: 1.25; p = 0.0558). Delayed patients incurred $36,740 higher health care costs over 3 years ($182,470 vs. $145,730; p < 0.01), driven primarily by increased hospitalizations ($22,127 difference). Results remained significant when restricted to elective procedures only. Delayed TAVR is associated with substantial clinical and economic consequences, including a 50% higher mortality risk and $36,740 in excess costs over 3 years. These findings support the importance of timely intervention and health care system investments to reduce TAVR wait times. • Delayed TAVR beyond 90 days increases 3-year mortality risk by 50% (HR: 1.50). • Delayed treatment results in $36,740 excess health care costs over 3 years. • Heart failure hospitalizations are 59% more likely with delayed TAVR (HR: 1.59). • Adverse outcomes persist even when restricting analysis to elective procedures. • Nearly half of patients experience treatment delays beyond recommended benchmarks.