TAVI In South Africa's resource-constrained economy: the role of local data in overcoming funding resistance

Abstract

Abstract The South African (SA) prospective multi-centre observational SHARE-TAVI registry aims to provide local outcomes data on all TAVIs in State & Private sectors, to support local evidence-based policy evaluations, comparing outcomes to international data & identifying local variations. Methods and results All 14 implants centres voluntarily capture data into the web-based SHARE-TAVI registry. 1375 patients from Sept 2014-Jan 2020 had pre-TAVI clinical evaluations, 998 proceeded to TAVI & procedural data & complications recorded (VARC-2 criteria), 30d & annual follow up. State sector hospitals provide limited tertiary cardiac care due to severe resource constraints. 13% of TAVIs in SA are in State teaching hospitals, 6.2% of State implants are 2nd generation (2G) devices. In the Private sector the roll-out of TAVI is inhibited by funding resistance, particularly to higher-cost 2G valves. 1st generation (1G) implants comprise 30% of 2019 implants, funding policies leave patients with unaffordable co-payments for 2G valves. Local data (Table 1) shows peri- & 1-year mortality, & procedural success (average 95.4%, & in 2019 98.91%), which are comparable with international data. TAVI in SA is successful despite low volumes & resource limitations. Local data supports superiority of 2G over 1G i.t.o this data and hospital stay length, & unplanned valve-in-valves. No significant differences between 1G & 2G in re-admissions in year 1, but improved quality of life patients experience with TAVI implantation is notable in the NYHA class. Funding Acknowledgement Type of funding source: Other. Main funding source(s): SA Heart Association registry project funding. Unrestricted educational grants by Medtronic and Edwards Life Sciences