TranscatheterAorticValveReplacement: VariationsinUse, Charges, andGeographyintheUnitedStates

The useoftranscatheteraorticvalvereplacement(TAVR) intheUnitedStateshasbeen increasing butwithvariability. Weuseda100% sampleofMedicarebeneficiaries(MBs), from theCentersforMedicareandMedicaidServicesdatabase, whounderwentTAVR by cardiologistsbetween2015and2019. Westratifieddatabygeographicregion, rural/ urban areas, andprovider'sgender. WeexaminedtheaveragenumberofTAVRsperformed per100,000MBs, theaveragenumberofTAVRsperformedperindividualcardiologist, andtheaveragesubmittedcharge(ASC) perprocedure. ThenumberofTAVR per 100,000MBswassignificantlyvariableamongregionsinallyears(allP=0.028), except in2015(P=0.103), withthehighestratesbeingintheNortheastandthelowestbeing in theWest. ThenumberofTAVRspercardiologistwassignificantlydifferentamong regions onlyin2019(P=0.04), withtheNortheastshowingthehighestnumbersandthe South showingthelowest. TheASCwasalsosignificantlyvariableamongregionsinall years (allP=0.01). ThehighestASCwasintheMidwestforallyears, whereasthelowest was intheWestin2015to2016andintheSouthin2017to2019. Inallyears, thenumber of TAVRspercardiologistwashigherinurbanareasthaninruralareas(allP<0.05); however, ruralcardiologistshadhigherASCs(allP<0.05). ThenumberofTAVRprocedures percardiologistwasnotsignificantlydifferentbetweenmaleandfemalecardiologists (allP>0.1). FemalecardiologistshadasignificantlyhigherASConlyin2015 (P=0.034). Inconclusion, therearevariationsinTAVRuseandchargesforMBsaccording to geographic, urban, andruralregionsandtheperformingcardiologist'sgender. (c) 2023 ElsevierInc. Allrightsreserved.(AmJCardiol2023;205:363-368)