The Burden of Severe Symptomatic Aortic Stenosis in Spain: Can Capacity-Enhancing Innovations Play a Role in Addressing the Growing Demand for Treatment?

Speaker(s)

Bermúdez EP1, de la Torre Hernández JM2, Zamorano JL3, García Del Blanco B4, Sarmah A5, González García P6, Ibañez Ortigosa F7
1Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain, 2Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain, 3University Hospital Ramon y Cajal, Madrid, Spain, 4Hospital Universitari Vall d'Hebrón, Barcelona, Barcelona, Spain, 5Edwards Lifesciences Sàrl, Nyon, VD, Switzerland, 6Edwards Lifesciences, Valencia, Valencia, Spain, 7Edwards Lifesciences, Barcelona, Spain

OBJECTIVES: Recent publications have reported a growing burden of symptomatic severe aortic stenosis (sSAS) in Europe. This might be problematic for health systems already facing capacity issues in meeting patient needs. Herein the adoption of ‘capacity-enhancing innovations’, defined as technologies combined with optimized patient care pathways which when adopted release capacity in the form of redeployable resources back into a healthcare system enabling better care for more patients with existing resources, could be helpful. This study aims to estimate the burden of sSAS in Spain and evaluate the role of capacity-enhancing innovations such as, transcatheter aortic valve implantation (TAVI) in enabling the Spanish national health system (SNS) to address the burden.

METHODS: Two published models, one estimating the burden of sSAS and another estimating the impact of waiting lists for SAS treatment on mortality were adapted to the SNS setting using literature estimates and public data. A panel of 4 clinical experts validated the models and the inputs.

RESULTS: In 2040, 399,752 SAS patients ≥ 65 years (273,030 symptomatic) are estimated in Spain, a 43% increase relative to 2024. Between 2024 and 2040, TAVI candidates would increase by 44,690, SAVR by 24,000 and medical management by 14,069. A 20% health system capacity increase could eliminate the sSAS backlog within 322 days with 293 deaths while awaiting treatment. A SAVR to TAVI case conversion (20%) would take longer (1083 days) with higher associated mortality (858). However, a combination of capacity increase (20%) and case conversion (20%) would clear the backlog in fewer days (268) with fewer deaths while awaiting treatment (246) and is the best strategy to meet the anticipated increase in sSAS treatment demand.

CONCLUSIONS: This study reports a growing burden of sSAS in Spain. Increasing capacity and adopting capacity-enhancing innovations such as, TAVI could help SNS meet the future demands for sSAS treatment.

Code

EPH5

Topic

Epidemiology & Public Health

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices