A Decade of Transcatheter Aortic Valve Implantation in New Zealand: Growth and Inequalities

Background Transcatheter aortic valve implantation (TAVI) is an effective treatment increasingly performed for severe aortic stenosis. Developing nationwide accessibility to TAVI can be met with barriers that result in treatment disparities.Objectives This nationwide retrospective study aimed to review the first decade of TAVI in New Zealand and identify potential inequalities.Methods All patients undergoing TAVI in a New Zealand public hospital between 2008 and 2018 were included. Demographic and geographic details were analysed and TAVI rates were age standardised using census data. One-year survival was compared between groups.Results A total of 952 patients were included in our study. The mean age was 80.0 +/- 7.5 years and women accounted for nearly half of all patients (42.5%). The age-standardised TAVI rate in New Zealand increased from 15 per million in 2013 to 49 per million in 2018. Since 2013, there has been a disproportionate growth in TAVI rates between different ethnicities. TAVI rates for Europeans grew from 16 to 66 per million compared to 7 to 8 per million for Pacific people and 3 to 5 per million for Maori. Despite nationwide access to TAVI in 2018, significant geographic heterogeneity remains, ranging from 2.0 to 12.8 procedures per 100,000 people between regions. One-year (1-yr) survival for Maori were significantly worse than Europeans (80.1% vs 93.9%, HR 4.2, 95%CI: 1.6-11.5, p=0.004) despite being younger (67.9 vs 80.6 years, p < 0.05).Conclusion There are significant geographical and ethnic variations in TAVI rates in New Zealand. Maori had worse one-year survival than European patients following TAVI.