Sex Differences in the Clinical Recognition of Significant Aortic Stenosis

Women with significant aortic stenosis (AS) are under-represented among patients undergoing aortic valve replacement in the United States as compared with men despite similar disease prevalence.

This study evaluated the impact of sex on the clinical recognition of significant AS following diagnostic transthoracic echocardiogram (TTE).

Using data from a large administrative multicenter database, we assessed rates of clinical diagnosis of AS defined by assignment of an Internal Classification Diagnosis (ICD) code for AS following a diagnostic TTE. Fine-Gray models were used to evaluate the 1-year cumulative rate of AS diagnosis by sex, AS severity, and AS phenotype accounting for competing risk of death.

Among 2,036 included patients (48.9% female, 51.1% male), the 1-year rate of clinical recognition following a diagnostic TTE with at least moderate AS was low (52.4%), and women were less likely as compared with men to receive a clinical diagnosis of AS (55.7% male vs 48.9% female; P = 0.003). Specifically, among patients with severe AS, women were less likely to receive an ICD diagnosis as compared with males (64.1% vs 74.3%), driven primarily by lower rates of clinical recognition of severe low gradient AS (66.9% male vs 54.3% female; P = 0.004).

Rates of clinical recognition of AS following a diagnostic TTE are low, and vary significantly by sex, AS disease severity, and severe AS phenotype. Further studies are needed to maximize the clinical recognition of TTE-confirmed AS and to mitigate sex disparities in diagnosis and treatment.