Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections

Andras P. Durko, Ruben L. Osnabrugge, Nicolas M. Van Mieghem, Milan Milojevic, Darren Mylotte, Vuyisile T. Nkomo, A. Pieter Kappetein

Research output: Contribution to journalArticle

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Abstract

Aims: The number of transcatheter aortic valve implantation (TAVI) procedures is rapidly increasing. This has a major impact on health care resource planning. However, the annual numbers of TAVI candidates per country are unknown. The aim of this study was to estimate current and future number of annual TAVI candidates in 27 European countries, the USA and Canada. Methods and results: Systematic literature searches and meta-analyses were performed on aortic stenosis (AS) epidemiology and decision-making in severe symptomatic AS. The incidence rate of severe AS was determined. Findings were combined with population statistics and integrated into a model employing Monte Carlo simulations to predict the annual number of TAVI candidates. Various future scenarios and sensitivity analyses were explored. Data from 37 studies (n = 26 402) informed the model. The calculated incidence rate of severe AS was 4.4‰/year [95% confidence interval (95% CI) 3.0-6.1‰] in patients ≥65 years. AS-related symptoms were present in 68.3% (95% CI 60.8-75.9%) of patients with severe AS. Despite having severe symptomatic AS, 41.6% (95% CI 36.9-46.3%) did not undergo surgical aortic valve replacement. Of the non-operated patients, 61.7% (95% CI 42.0-81.7%) received TAVI. The model predicted 114 757 (95% CI 69 380-172 799) European and 58 556 (95% CI 35 631-87 738) Northern-American TAVI candidates annually. Conclusion: Currently, approximately 180 000 patients can be considered potential TAVI candidates in the European Union and in Northern-America annually. This number might increase up to 270 000 if indications for TAVI expand to low-risk patients. These findings have major implications for health care resource planning in the 29 individual countries.

Original languageEnglish (US)
Pages (from-to)2635-2642
Number of pages8
JournalEuropean heart journal
Volume39
Issue number28
DOIs
StatePublished - Jul 21 2018

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Aortic Valve Stenosis
Confidence Intervals
Health Resources
Delivery of Health Care
Transcatheter Aortic Valve Replacement
Incidence
European Union
Population Characteristics
North America
Aortic Valve
Surgical Instruments
Canada
Meta-Analysis
Decision Making
Epidemiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Durko, A. P., Osnabrugge, R. L., Van Mieghem, N. M., Milojevic, M., Mylotte, D., Nkomo, V. T., & Pieter Kappetein, A. (2018). Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections. European heart journal, 39(28), 2635-2642. https://doi.org/10.1093/eurheartj/ehy107

Annual number of candidates for transcatheter aortic valve implantation per country : current estimates and future projections. / Durko, Andras P.; Osnabrugge, Ruben L.; Van Mieghem, Nicolas M.; Milojevic, Milan; Mylotte, Darren; Nkomo, Vuyisile T.; Pieter Kappetein, A.

In: European heart journal, Vol. 39, No. 28, 21.07.2018, p. 2635-2642.

Research output: Contribution to journalArticle

Durko, AP, Osnabrugge, RL, Van Mieghem, NM, Milojevic, M, Mylotte, D, Nkomo, VT & Pieter Kappetein, A 2018, 'Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections', European heart journal, vol. 39, no. 28, pp. 2635-2642. https://doi.org/10.1093/eurheartj/ehy107
Durko, Andras P. ; Osnabrugge, Ruben L. ; Van Mieghem, Nicolas M. ; Milojevic, Milan ; Mylotte, Darren ; Nkomo, Vuyisile T. ; Pieter Kappetein, A. / Annual number of candidates for transcatheter aortic valve implantation per country : current estimates and future projections. In: European heart journal. 2018 ; Vol. 39, No. 28. pp. 2635-2642.
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abstract = "Aims: The number of transcatheter aortic valve implantation (TAVI) procedures is rapidly increasing. This has a major impact on health care resource planning. However, the annual numbers of TAVI candidates per country are unknown. The aim of this study was to estimate current and future number of annual TAVI candidates in 27 European countries, the USA and Canada. Methods and results: Systematic literature searches and meta-analyses were performed on aortic stenosis (AS) epidemiology and decision-making in severe symptomatic AS. The incidence rate of severe AS was determined. Findings were combined with population statistics and integrated into a model employing Monte Carlo simulations to predict the annual number of TAVI candidates. Various future scenarios and sensitivity analyses were explored. Data from 37 studies (n = 26 402) informed the model. The calculated incidence rate of severe AS was 4.4‰/year [95{\%} confidence interval (95{\%} CI) 3.0-6.1‰] in patients ≥65 years. AS-related symptoms were present in 68.3{\%} (95{\%} CI 60.8-75.9{\%}) of patients with severe AS. Despite having severe symptomatic AS, 41.6{\%} (95{\%} CI 36.9-46.3{\%}) did not undergo surgical aortic valve replacement. Of the non-operated patients, 61.7{\%} (95{\%} CI 42.0-81.7{\%}) received TAVI. The model predicted 114 757 (95{\%} CI 69 380-172 799) European and 58 556 (95{\%} CI 35 631-87 738) Northern-American TAVI candidates annually. Conclusion: Currently, approximately 180 000 patients can be considered potential TAVI candidates in the European Union and in Northern-America annually. This number might increase up to 270 000 if indications for TAVI expand to low-risk patients. These findings have major implications for health care resource planning in the 29 individual countries.",
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AU - Osnabrugge, Ruben L.

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AU - Milojevic, Milan

AU - Mylotte, Darren

AU - Nkomo, Vuyisile T.

AU - Pieter Kappetein, A.

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