{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:43:04Z","timestamp":1790289784948,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T00:00:00Z","timestamp":1721433600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011593","name":"ICES","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Demand for transcatheter aortic valve implantation (TAVI) has increased in the last decade, resulting in prolonged wait-times and undesirable health outcomes in many health systems. Risk-based prioritization and wait-times benchmarks can improve equitable access to patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We used simulation models to follow-up a synthetic population of 50\u2009000 individuals from referral to completion of TAVI. Based on their risk of adverse events, patients could be classified as \u2018low-\u2019, \u2018medium-\u2019, and \u2018high-risk\u2019, and shorter wait-times were assigned for the higher risk groups. We assessed the impacts of the size and wait-times for each risk group on waitlist mortality, hospitalization, and urgent TAVIs. All scenarios had the same resource constraints, allowing us to explore the trade-offs between faster access for prioritized patients and deferred access for non-prioritized groups. Increasing the proportion of patients categorized as high-risk, and providing more rapid access to the higher-risk groups achieved the greatest reductions in mortality, hospitalizations and urgent TAVIs (relative reductions of up to 29%, 23%, and 38%, respectively). However, this occurs at the expense of excessive wait-times in the non-prioritized low-risk group (up to 25 weeks). We propose wait-times of up to 3 weeks for high-risk patients and 7 weeks for medium-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prioritizing higher-risk patients with faster access leads to better health outcomes, however this also results in unacceptably long wait-times for the non-prioritized groups in settings with limited capacity. Decision-makers must be aware of these implications when developing and implementing waitlist prioritization strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcae059","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T22:18:22Z","timestamp":1721427502000},"page":"10-18","source":"Crossref","is-referenced-by-count":6,"title":["Wait-times benchmarks for risk-based prioritization in transcatheter aortic valve implantation: a simulation study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-0021","authenticated-orcid":false,"given":"Rafael N","family":"Miranda","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto M5T 3M6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3337-233X","authenticated-orcid":false,"given":"Peter 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,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-8890","authenticated-orcid":false,"given":"Mamas A","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, School of Medicine, Keele University , Stoke-on-Trent ST5 5BG,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-5133","authenticated-orcid":false,"given":"Maneesh K","family":"Sud","sequence":"additional","affiliation":[{"name":"ICES , Toronto M4N 3M5 ,","place":["Canada"]},{"name":"Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , Toronto M4N 3M5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0621-0637","authenticated-orcid":false,"given":"David M J","family":"Naimark","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto M5T 3M6 ,","place":["Canada"]},{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto M5S 1A8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-1080","authenticated-orcid":false,"given":"Harindra C","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto M5T 3M6 ,","place":["Canada"]},{"name":"ICES , Toronto M4N 3M5 ,","place":["Canada"]},{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto M5S 1A8 ,","place":["Canada"]},{"name":"Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , Toronto M4N 3M5 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