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\begin{document}

\title{Our Experience with TAVR Accessibility}



\author[1]{Frank Annie}%
\author[1]{Aravinda Nanjundappa}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{May 23, 2024}


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Frank H Annie, PhD\textsuperscript{1}; Aravinda Nanjundappa,
MD\textsuperscript{2};

\textsuperscript{1}CAMC Health Education and Research Institute

3200 MacCorkle Ave. SE, Charleston, WV 25304.

\textsuperscript{2}CAMC Vascular Center of Excellence, Charleston Area
Medical Center.

3200 MacCorkle Ave SE, Charleston, WV 25304

\par\null

\emph{Study Locations:}

Charleston Area Medical Center, 3100 McCorkle Ave SE, Charleston, WV,
25302 and Charleston Area Medical Center Research Institute and Center
for Clinical Sciences Research, 3200 McCorkle Ave SE, Charleston, WV,
25302

\emph{Correspondence:}

Frank Annie M.A; MPA, PhD

Research Scientist

CAMC Health Education and Research Institute

3200 MacCorkle Ave. SE,

Charleston, WV 25304

Phone 304-388-9921

Fax: 304-388-9921

Email:\emph{Frank.H.Annie@camc.org}

\emph{Total word count:} 672

\emph{Author Disclosure Block:} None

\emph{Key words:} \textbf{TAVR Accessibility}

\emph{Running Title:} \textbf{Our Experience with TAVR Accessibility}

\emph{Total Number of Tables and Figures:} \textbf{Figures 1}

Access to care is essential for both a safe and stable health care
system. It is imperative that we continue to refine individual programs
and better address the unique needs of populations that are often
overlooked. It has been documented that rural populations in the United
States (US) face barriers to health care that in turn negatively impact
their health (1). The US Census Bureau defines rural as all population,
housing, and territory not included within an urbanized area or urban
cluster (2), in which nearly 1/5 of the US population resides.

Transcatheter aortic valve replacement (TAVR) continues to evolve as a
minimally invasive approach that enables percutaneous implantation of an
aortic valve bioprosthetic in patients with aortic stenosis who would
otherwise require open cardiac surgery. However, candidates within rural
populations may not directly or fully receive its benefits. The barriers
to adequate cardiovascular care that rural TAVR candidates endure are
compounded by the well-documented hemodynamic changes observed
post-procedure. There is evidence, however, that aortic stenosis
patients living in these rural areas or clusters, especially those above
the age of 80, can receive benefit from TAVR procedures performed at
smaller, rural centers comparable or superior to the results documented
at urban tertiary care centers (3). In addition to the scarcity of data
suggesting that cardiac device implantation does not apply to CVD
prevention and treatment disparities in rural designations, there is
little evidence concerning access of TAVR procedures to candidates in
these areas or clusters (4). As severe valvular disease increases with
age and given that the number of residents aged 65 and over in the
Appalachian region of the US exceeds the national average by over 2\%
(5), we chose to geocode TAVR cases performed by our Structural Heart
Program at Charleston Area Medical Center (CAMC), a rural tertiary care
center in Kanawha County, West Virginia. We aimed to identify TAVR
patients from rural territories and housing who have limited access
through spatial analysis.

We selected 323 TAVR cases that were performed at the Charleston Area
Medical Center (CAMC) Memorial Campus. These cases were pulled from the
CAMC data warehouse. Of the 323 chosen, 232 had a complete home address
for analysis. We then geocoded 232, in which we conducted a collective
study and hot spot analysis.

The results we obtained suggest that within a 30-mile distance of our
TAVR center, the majority of our cases being treated with limited access
appear to come from the coalfields of Southern West Virginia. The
collective analysis illustrates this in Figure 1 with circles denoting
cases 1-15. The majority of cases were then analyzed using a hot spot
analysis which demonstrated the areas in which our program is valid
within a zip code function (p\textless{}0.001). The hot spot analysis
also showed that there are more significant concentrations of TAVR cases
with host zip codes around our center shown in Figure 1.

As health delivery networks continue to improve nationally, access
remains a challenge for large-scale organizations. As the largest
tertiary health care network in the state of West Virginia we, along
with other centers like us, must improve health delivery access.
Establishing mobile screening through referrals for conditions such as
aortic stenosis may help us and other institutions remove or reduce some
barriers that rural populations face.

\textbf{Figure Legend}

\textbf{Figure 1 -- TAVR Accessibility Map}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

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\textbf{References}

\begin{enumerate}
\tightlist
\item
  Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important
  barriers to health care access in the rural USA. Public Health.
  2015;129(06):611--620.
\item
  Ratcliffe M, Burd C, Holder H, Fields A. \emph{Defining Rural at the
  US Census Bureau ACSGEO-1} . Washington, DC: US Census Bureau; 2016.
\item
  Klinkhammer BJ. Outcomes following transcatheter aortic valve
  replacement for aortic stenosis in patients of extreme age: Analysis
  from a rural population. Res Cardiovasc Med 2018;7:98-102.
\item
  Sukul D, Allen J, Kumbhani DJ. Volume considerations for Transcatheter
  aortic valve replacement in Medicare's National Coverage
  Determination. Circ Cardiovasc Qual Outcomes. 2019;12:e005216.
\item
  Pollard K, Jacobsen LA. The Appalachian region: a data overview from
  the 2013--2017 American community survey chartbook; 2019 May.
\end{enumerate}

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