Higher Hospital TAVR Volume Associated With Lower 30-Day Stroke Rates

A retrospective cohort study examined whether county-level socioeconomic characteristics were associated with short-term transcatheter aortic valve replacement (TAVR) outcomes independently of hospital procedural volume. Researchers analyzed 336 hospital-measure observations from 85 California hospitals in the CMS TAVR database during 2022–2023. Hospital risk-adjusted 30-day mortality and stroke rates were linked to county income, insurance coverage, and racial composition using mixed-effects models adjusted for year and procedural volume.

Higher log-transformed TAVR volume was associated with lower mortality (β=-0.334; 95% CI, -0.651 to -0.018; p=0.046) and stroke (β=-0.541; 95% CI, -0.844 to -0.237; p=0.001). In sensitivity analyses using log-transformed observed-to-expected ratios, the stroke association persisted (p=0.010), but mortality was no longer statistically significant (p=0.072). County income and racial composition were not associated with mortality. An unadjusted association between lower county income and lower stroke rates disappeared after full adjustment (p=0.854), and no significant income–volume interaction was identified.

Procedural volume was the most reproducible correlate of favorable outcomes, particularly stroke, supporting further investigation of care delivery at experienced TAVR centers. However, this observational, ecological analysis cannot establish causality or exclude patient-level socioeconomic disparities. County-level findings should not be interpreted as evidence of equitable access or outcomes for individual patients.