Improving the Uptake of TAVR in Ontario

Despite an increased rate of TAVR since 2011, with 28 TAVR centers in Canada, except for two provinces (Saskatchewan and Newfoundland), there is yet an observed asymmetry in the uptake of TAVR across Canada institutions when compared to other developed countries (Asgar et al., 2018). Our aims are: 

 

To understand the principle reasons why SAVR is chosen over TAVR; and to develop an evidence-based intervention to promote TAVR as the preferred alternative in patients deemed intermediate to high risk for surgery. 

This research is a three-phase mixed-method design that consists of; an online survey, a virtual co-design session to explore the decision-making behind performing either SAVR or TAVR therapies, and a pilot phase to test the intervention developed to improve the evidence-based update of TAVR. We developed a survey to understand the characteristics of the decision-makers and the reasons why one therapy is preferred over another. The survey will be administered in an electronic format to a maximum of 385 identified decision-makers (interventional cardiologists, surgeons, nurses, and organization’s heart team) for TAVR and SAVR across hospitals in Toronto. The second phase will include a virtual co-design session with a group of respondents. The third phase will involve a low fidelity testing of the intervention through an electronic survey of five decision-makers to identify if the intervention works and if this will change or impact their decision making. We hope that this project will contribute to the understanding of the dissemination, implementation, and adoption of new standards of care.