Sex-Based Patterns and Trends in Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Sex-related disparities are known to influence the diagnosis, referral, and prognosis of aortic valvular diseases.
• Limited contemporary US data exist on transcatheter aortic valve implantation (TAVI) outcomes stratified by sex.

Purpose of the Study:

• To analyze 10-year trends in TAVI utilization, periprocedural complications, and long-term outcomes among Medicare beneficiaries.
• To stratify these trends by sex to identify potential disparities.

Main Methods:

• Nationwide, retrospective, population-based cohort study using US Medicare claims data (2013-2022).
• Included fee-for-service beneficiaries undergoing TAVI, excluding specific complex cases and Medicare Advantage conversions.
• Primary outcome: all-cause mortality. Secondary outcomes: periprocedural mortality, vascular complications, acute kidney injury, bleeding, stroke, myocardial infarction, pacemaker implantation, and heart failure hospitalization.

Main Results:

• The study included 314,123 patients (45.0% women).
• The proportion of women undergoing TAVI declined from 47.6% in 2013 to 43.6% in 2022.
• Women experienced higher rates of periprocedural mortality, vascular complications, and bleeding compared to men, but had lower rates of permanent pacemaker implantation.
• Long-term mortality was lower in women, despite higher risks of heart failure hospitalization, myocardial infarction, stroke, and bleeding.

Conclusions:

• Women represent a declining proportion of TAVI patients, face increased periprocedural complications, yet exhibit improved long-term survival compared to men.
• Further investigation is required to understand trends and develop sex-specific strategies for optimizing TAVI outcomes.