Sex-Associated Disparities in Surgical and Percutaneous Management of Aortic Stenosis With Severe Features: Retrospective Analysis From the National Readmission Database.

BACKGROUND

Referral for valve intervention for severe aortic stenosis (AS) may exhibit sex-associated disparities independent of the growth of transcatheter interventions. This study aimed to determine whether there were sex-associated differences in the use of aortic valve replacement (AVR), either surgical or transcatheter, in patients with aortic stenosis and severe features from a national cohort of patients.

METHODS

Using the National Readmission Database, all patients with an index diagnosis of AS between January 2015 and December 2019 were included and stratified by their 90-day readmission status and sex. AS with severe features was defined as the combination of primary- or secondary-coded diagnosis of AS in combination with heart failure, syncope, angina pectoris, cardiac arrest, or cardiogenic shock. A 1:1 nested case-control matching was performed to account for competing risk. The main investigated outcome was the sex-associated rate of AVR in the 90 days after index hospitalization.

RESULTS

A total of 31 712 matched weighted discharges were included in the analysis, 16 597 men (52.3%) and 15 116 women (47.7%). At 90 days, the rate of AVR was significantly lower in women (45.7% versus 53.6%, <0.001) with significant difference for both surgical (<0.001) and transcatheter (=0.010) interventions. After multivariable adjustment, these differences persisted with women significantly less likely to receive AVR (adjusted odds ratio [aOR], 0.67 [95% CI, 0.63-0.71], <0.001), either surgical AVR (aOR, 0.48 [95% CI, 0.43-0.54], <0.001) or transcatheter aortic valve implantation (aOR, 0.79 [95% CI, 0.75-0.84], <0.001).

CONCLUSIONS

The use of surgical AVR and transcatheter aortic valve implantation was significantly lower in female patients with AS and severe features independent from patient- and hospital-level characteristics.