At the 2024 U.S.-Taiwan Patient Day Innovation Forum, held by AmCham Taiwan and the American Institute in Taiwan, Shih Chung-liang, director-general of the National Health Insurance Administration (NHIA), had his finger on the pulse of cardiovascular health. Shih emphasized the profound benefits of expanding the use of transcatheter aortic valve implantation (TAVI), especially for patients ineligible for conventional surgery.
TAVI offers a less invasive alternative, typically performed using a catheter inserted through a small incision in the leg. Guided by advanced imaging techniques, the catheter is navigated through the blood vessels to the heart, where a replacement valve, pre-mounted on a balloon, is precisely placed and expanded within the existing valve. This method requires a shorter procedure time and reduces the risks of infection.
“Patients typically return to normal activities within a few weeks, a stark contrast to the months needed post-open-heart surgery,” notes Professor Hsieh I-chang, director of the Percutaneous Coronary Intervention Center at Chang Gung Memorial Hospital. This rapid recovery also minimizes the expense and burden to the healthcare system caused by extended hospital stays and postoperative care.
Furthermore, TAVI streamlines the process and helps patient self-care: 95.8% of patients who underwent TAVI were able to go home or take care of themselves after surgery (compared to 73.1% of surgical aortic valve replacement patients).
Technologies like TAVI are now evolving to treat patients earlier, potentially reversing or preventing heart failure (HFrEF) and renal disease – another top financial burden for the NHIA. Having shown remarkable efficacy across various surgical risk categories, TAVI is now extending its benefits to a broader patient demographic that includes lower-risk and younger patients.
“TAVI is indicated and proven for all surgical risk patients, including the younger elderly, down to 65 years old,” says Dr. Hsieh. “We were very happy in 2021 when the NHIA decided to conditionally reimburse TAVI to help more patients.”
Further emphasizing this benefit, Dr. Hsieh notes a recent U.S. study that analyzed the benefits of unpaid work in the elderly against the costs of TAVI treatment. The study found that treating patients with TAVI yielded a return rate of 395%.
Global guidelines are expanding to include TAVI for a broader range of patients, continuing to evolve the procedure’s role in streamlining cardiac care. With advancements in procedural techniques and expanding indications, TAVI offers hope and enhanced quality of life to patients in Taiwan and beyond.
Highlighting TAVI’s unquantified benefit to society, Erik Ramp, director of commercial management at Edwards Lifesciences Taiwan, says that in Taiwan, grandparents play such an active role in raising and educating the grandchildren.
“As working parents in Taiwan, we depend on their help to balance the demands of business travel and long hours at work,” he says. “Treating these elderly patients can have a huge benefit we don’t always see.”
As Taiwan transitions into a super-aged society, with more than 20% of the population aged 65 or above, demand for treatments like TAVI is expected to rise together with increased prevalence of aortic stenosis and other age-related cardiac conditions. At a time when heart disease is a leading cause of death, the importance of widespread adoption has already been recognized.
It is the stated strategy of the NHIA to invest more resources in treating early stages of disease. “We know treating heart valve disease can help prevent heart failure, and heart failure is a huge cost to the health insurance and healthcare system,” says Ramp.
He further notes that “Edwards has always been a company with a deep commitment to treating structural heart disease, or more plainly speaking, the diseases of our heart valves and related structures.”
For more than six decades, Edwards Lifesciences has maintained an unwavering dedication to the heart. Specializing in artificial heart valves, the company has pioneered innovations that have been particularly transformative in the development and refinement of TAVI, also known as Transcatheter Aortic Valve Replacement (TAVR), improving patient outcomes worldwide.
In July, Edwards reaffirmed this dedication through strategic acquisitions, expanding its portfolio to include structural heart and heart failure products. Edwards will now not only be able to address the unmet needs of a larger pool of aortic regurgitation, mitral regurgitation, and heart failure patients but also become a leader in providing access to life-saving technologies for patients globally.
Edwards Lifesciences remains committed to pushing the boundaries of what’s possible in cardiovascular care, making pivotal strides in technology and treatment that profoundly impact patient care and health system sustainability.