Exploring TAVR Access Disparities: Geographic and Demographic Perspectives

Transcatheter aortic valve replacement (TAVR) is increasingly favored for appropriate candidates because centralizing specialized structural heart expertise can improve procedural quality and outcomes. In Medicare beneficiaries—the population most affected by service distribution—this shift results in longer median travel times compared with surgical aortic valve replacement (SAVR), reflecting greater distance and time to reach TAVR centers.

A national Medicare beneficiary sample (n=12,345) compared driving-time patterns to TAVR versus SAVR. Median driving time to TAVR centers was 42 minutes (IQR 18–96) versus 23 minutes (IQR 12–48) for SAVR—a median differential of 19 minutes favoring SAVR. Notably, mapped driving time to TAVR centers clustered around regional hubs rather than being evenly distributed across service areas, substantiating geographic barriers to access.

Older beneficiaries, racial and ethnic minority groups, and residents of rural counties experienced worse access in the analysis, with effect sizes linked to longer travel distances and a scarcity of proximate procedural sites. Referral patterns that concentrate cases at high-volume centers appear to amplify access differences for patients with limited mobility or transportation resources. Conversely, urban beneficiaries and those living near tertiary centers had shorter travel times, indicating that proximity and institutional density are principal mechanisms. The equity takeaway: regionalized TAVR service delivery currently produces measurable inequities in access for older, minority, and rural Medicare beneficiaries.

Regionalization concentrates expertise but increases travel burdens for patients outside hub catchment areas, and this concentration can widen disparities when center placement and referral networks are not aligned with population need. System effects observed include referral-network consolidation that funnels patients toward fewer centers and operational pressures that favor centralized evaluation pathways. Transport support and tele-evaluation strategies were noted as practical mitigations that reduce travel-related barriers. Analytic priorities for planners therefore include evaluating capacity, catchment geography, and referral flows to define where regionalization improves outcomes and where it creates access shortfalls.