Disparities in Access to TAVR for Medicare Beneficiaries

A national analysis found transcatheter aortic valve replacement (TAVR) is less geographically accessible than surgical aortic valve replacement (SAVR) for Medicare beneficiaries, with longer median driving times to TAVR centers.

That difference matters: access, timeliness, and referral logistics shape evaluation and treatment for older patients. Longer travel times can delay evaluation and progression to definitive valve intervention and complicate follow-up for medically complex patients.

Despite rapid expansion of TAVR programs, availability has not translated into nearer care: many communities remain farther from TAVR centers than from surgical programs.

Investigators computed driving times from residential zip-code centroids to procedural-center zip codes using the Google Distance Matrix API and a distance-matrix algorithm to estimate road travel time. They report a median driving time to the nearest TAVR center of 59 minutes (IQR, 30–96) versus 44 minutes (IQR, 24–73) to the nearest SAVR center; 24.3% of zip codes were more than one hour from a TAVR center compared with 13.1% for SAVR. The cohort included 29,089 US residential zip codes, with 407 zip codes containing a TAVR center and 639 containing a SAVR center.

Zip codes with higher median age, a higher Hispanic-to-White ratio, and locations outside metropolitan areas were more likely to be more than one hour from TAVR centers. Longer driving times clustered in the western and southern US, consistent with uneven center distribution and referral or operational factors that reduce proximity. These associations link longer travel times to potential delays in care and to inequitable access for affected Medicare beneficiaries.

Key Takeaways:

• TAVR access is measurably worse than SAVR access: longer travel times can delay evaluation and affect preprocedure optimization.
• Longer driving times for TAVR patients may alter procedural planning and referral patterns, particularly for patients with limited mobility or tight scheduling constraints.
• Access disparities warrant explicit consideration when designing referral networks and preprocedural pathways to reduce travel burden and improve timeliness of care.