Patients in underserved and rural communities have to travel much farther to reach hospitals that perform life-saving valve surgery. It is an issue, experts warn, that perpetuates disparities in health care.
And its top of mind for those who treat patients with tricuspid regurgitation disease, an undertreated form of heart value disease that disproportionately affects Black and Hispanic people.
About Tricuspid Regurgitation
Over 1.6 million Americans live with moderate or severe tricuspid regurgitation, a condition in the heart that allows blood to flow backward because the tricuspid valve does not close properly. It causes debilitating symptoms like severe fatigue and breathlessness and can lead to other complications affecting the liver and kidneys.
Recent advancements in the treatment of tricuspid regurgitation, such as transcatheter tricuspid edge-to-edge repair – a procedure often abbreviated to “T-TEER” – using a TriClip G4 System offers a safe option to keep blood flowing properly in the heart. It has also been shown to lower mortality risk as well as rates of heart attack, pulmonary hypertension, atrial fibrillation and severe heart failure presentation.
T-TEER is less invasive than most other treatment approaches like open heart surgery, which is one reason medical groups are expressing their opinions about federal coverage of the minimally invasive device.
A Unified Call to Expand T-TEER Coverage
Physicians and other professionals who work with tricuspid regurgitation patients recently submitted a joint statement for the T-TEER National Coverage Analysis.
A joint letter signed by the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons, conveys a simple message: Medicare should provide coverage for T-TEER.
A letter from the Heart Valve Disease Policy Task Force goes so far as to assert that Medicare should cover “all FDA-approved minimally invasive transcatheter devices is essential for improving outcomes for patients suffering from symptomatic tricuspid regurgitation (TR).” While only one device is currently available, others are in development.
Supporting Equitable Access
The joint letter goes on to argue that coverage requirements should be based on patient safety, not volume of surgeries. Smaller hospitals often don’t qualify for coverage because they see fewer patients but may be just as well staffed and equipped to provide minimally invasive, cutting-edge care to heart-value patients. Those patients, and those heart teams, should not be excluded from T-TEER coverage.
The current coverage policies exacerbate health disparities by favoring early adoption of the procedure in high-volume hospitals. But life-saving treatment for heart value patients should not be limited by proximity to urban centers, especially when long-term survival of heart value disease is contingent on access to treatment.
A National Coverage Determination should promote equitable access by allowing smaller and rural hospitals to participate from the beginning, removing barriers for patients every community that has skilled medical teams who could safely provide the procedure.
