Title: Temporal trends in utilization of transcatheter aortic valve replacement and patient characteristics: a nationwide study.

Structured abstract Aim To investigate trends in the utilization of transcatheter aortic valve replacement (TAVR) and changes in the characteristics of patients undergoing first-time TAVR. Methods Using Danish nationwide registers, we included all patients undergoing TAVR between 2008 and 2020. To compare patient characteristics, the study population was stratified according to calendar year of procedure: 2008–2010, 2011–2013, 2014–2016, and 2017–2020. Results We identified 6,097 patients undergoing TAVR with year-by-year increases in TAVR penetration rate. Over time, the age of the patients remained stable (2008–2010: median age 82 year [interquartile range (IQR): 77–86] vs. 2017–2020: median age 81 years [IQR: 77–85]). Moreover, there was an increase in male patients (2008–2010: 49.9% vs 2017–2020: 57.4%) and patients with diabetes (2008–2010: 14.2% vs. 2017–2020: 19.2%). Conversely, a history of stroke (2008–2010: 15.8% vs. 2017–2020: 13.1%), previous myocardial infarction (2008–2010: 22.4% vs. 2017–2020: 10.0%), heart failure (2008–2010: 40.5% vs. 2017–2020: 25.2%), and peripheral artery disease (2008–2010: 14.8% vs. 2017–2020: 10.4) decreased among patients. Conclusions TAVR utilization increased markedly in the years 2008–2020. Patients undergoing TAVR had less comorbidity over time while age remained stable. Thus, despite expanding to patients at lower surgical risk, TAVR is still offered mainly to older patients. Condensed abstract Guidelines lists transcatheter aortic valve replacement (TAVR) for treatment of symptomatic, severe aortic stenosis in patients at increased surgical risk. However, intermediate- and low-risk TAVR trials have recently been published, but it is largely unclear whether this has changed daily clinical practice. We identified 6,097 Danish patients undergoing first-time TAVR between 2008–2020. Over time, the overall comorbidity burden decreased with most noticeable declines for history of cardiovascular comorbidities and previous cardiac interventions while the age of patients at TAVR remained stable. Thus, despite expanding to patients at lower surgical risk, TAVR is still offered mainly to elderly patients.