Temporal Trends in Hospitalization and Interventions for Aortic Stenosis in Canada, 2012-2024

Abstract

Background

Given the paradigm shift from surgical aortic valve replacement (SAVR) to transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), we examined the temporal trends in AS hospitalization and treatment across Canada.

Methods

Data from the Canadian Institute for Health Information Discharge Abstract Database were used for a population-based cross-sectional study of inpatients between April 1, 2012, and March 31, 2024. We estimated national and provincial rates and reported the annual changes in hospitalization for AS, SAVR, and TAVI. Rates were expressed as episodes/procedures per million, and stratified by age group, sex, and urban-vs-rural residence.

Results

Between 2012 and 2024, hospitalizations for AS increased from 259.8 to 362.4 per million. Rates of SAVR declined from 104.4 to 66.5 per million, whereas rates of TAVI rose from 19.0 to 136.9 per million. The average annual per-million increases in AS hospitalizations were highest in Prince Edward Island (25.0), Nova Scotia (22.9), and Newfoundland and Labrador (21.3), particularly among individuals ≥ 80 years of age. The rates of SAVR declined, as the uptake of TAVI increased, with the shift mostly evident in those 60-79 years of age. Rates of TAVI were higher in men than in women, whereas AS hospitalizations were higher in rural than in urban areas.

Conclusions

Not unexpectedly there has been a dramatic shift from SAVR to TAVI observed, with an overall improvement in access to care. Nevertheless, sex-related and geographic disparities persist, highlighting the need for a coordinated national effort to ensure equitable access to AS management.