Women with severe symptomatic aortic stenosis experienced a significantly longer median delay from symptom onset to diagnosis compared to men (3 months vs. 1 month, p<0.001).
Are there sex-related differences in diagnostic and therapeutic delays and clinical outcomes among patients with severe symptomatic aortic stenosis referred for TAVI?
Women with severe symptomatic aortic stenosis experience significantly longer delays from symptom onset to diagnosis compared to men, highlighting a need for improved recognition and timely referral.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Severe aortic stenosis (AS) is a leading cause of morbidity and mortality worldwide. Timely diagnosis and treatment are essential, however, gender-related disparities in diagnosis and referral to transcatheter aortic valve implantation (TAVI) remain incompletely understood. Purpose The present study aims to evaluate sex-related differences in the diagnosis and referral to TAVI and assess the impact of diagnostic and therapeutic delays, as well as sex-specific characteristics, on clinical outcomes. Methods This multicentre, observational study investigated patients with severe symptomatic AS who were referred for TAVI in 2023 across three European centres. Clinical status and adverse events were evaluated according to the Valve Academic Research Consortium (VARC-3). Female-specific data included pregnancy and menstrual history, abortions, obstetric complications, breastfeeding, gynaecological surgery or cancer, hormone replacement therapy and osteoporosis. A total of 519 patients were included, 420 had a six-month follow-up and female-specific data was available for 169 women. Results Of the 519 patients, 239 (46.1%) were women. Women were older (median: 83 vs. 81.5 years, p0.001), had less coronary (27.6% vs. 46.6%, p0.001) and peripheral (11% vs. 18%, p=0.034) vascular disease. They presented with higher surgical risk (STS Score: 4.5 vs. 2.8, p0.001), slightly lower left ventricular ejection fraction (60 8% vs. 60 14%, p0.001) and smaller aortic annuli. At clinical presentation, more men were in NYHA class I and more women in class III. Diagnostic delay was longer in women, with a median time from symptom onset to diagnosis of three months compared with one month in men (3 9 vs. 1 4 months, p0.001). However, the median time from diagnosis to TAVI was similar (3 4.3 vs. 2.5 4 months, p=0.220). In multivariate analysis, the STS Score (OR: 0.872; 95% CI: 0.75-0.99; p=0.036) predicted device success. Therapeutic delay was associated with device success in univariate analysis (OR: 0.971; 95% CI: 0.94–1.00; p=0.041) but showed no statistically significant association in multivariate analysis (p=0.722). No significant interactions with either sex or country were observed. Conclusions Women with severe symptomatic AS experienced significantly longer delays from symptom onset to diagnosis. These delays may result from a combination of symptoms underrecognition, reporting differences or lower healthcare-seeking among women. However, once diagnosed, treatment is effective, with comparable in-hospital and six-month outcomes between sexes. Further research is needed to clarify these disparities and to ensure fair and timely diagnosis for all patients with AS.
Cascone et al. (Sun,) reported a other. Women with severe symptomatic aortic stenosis experienced a significantly longer median delay from symptom onset to diagnosis compared to men (3 months vs. 1 month, p<0.001).