Effect of Transcatheter Aortic Valve Replacement Program Rankings on Case Selection: An Interview With Ashwin Nathan, MD

In this video from the 2025 SCAI Scientific Sessions, JIC speaks with Dr Ashwin Nathan about the effect of public ratings of TAVR programs on hospital case selection.

Read the session summary here.

Transcript:

Hi, I'm Ashwin Nathan. I'm an assistant professor of medicine at the University of Pennsylvania and an editorial member of the Journal of Invasive Cardiology.

Can you please tell us what prompted your study?

Thanks! Well, we took advantage of a naturalized experiment that happened in 2020 when the first US News and World ratings for TAVR programs were introduced, and so that allowed us to study what was happening before and after the introduction of these ratings.

What was the mindset behind the use of the difference-in-difference study design?

The difference-in-difference study design takes advantage of naturalized experiments that can occur when something is introduced. It's been used by economists and econometric studies for many years, and so we're trying to use it in biomedical research.

Why did you choose to focus on TAVR for this study?

With CABG report cards and PCI public reporting, we saw that there was an influence of public reporting on outcomes as well as risk-avoidant behavior. And so with the introduction of these metrics for TAVR, we thought it would be ripe for studying to see if, with the introduction of quality metrics and public reporting of outcomes for TAVR, whether there was risk-avoidant behavior in this space as well.

Is the risk-avoidant behavior you observed in the study helpful to patients?

It's not helpful, and I think it's frankly harmful for patients. We know that TAVR is a life-saving therapy, one of the most life-saving therapies that we have within cardiology. And so not offering a patient this procedure because of perceived risk, it's detrimental to their care and can lead to mortality.