Urban, regional and remote outcomes following TAVR for Queensland patients: a retrospective cohort study

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%]; χ 2 =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.