Certain patient populations are disproportionately affected by aortic stenosis (AS) underdiagnosis1-3
Globally, cardiovascular disease is the leading cause of death in women. Yet they are particularly vulnerable to underdiagnosis and undertreatment.1,4
Key differences in pathophysiology and clinical presentation exist between men and women with AS1,4
Women are more prone to paradoxical low-flow, low-gradient AS, which can play a role in delayed diagnosis and referral for AVR4
Women present with more aortic valve fibrosis than calcification and have different processes of cardiac remodeling4
Women have a worse prognosis than men, including increased risk of cardiac events and mortality due to left ventricular hypertrophy5,6
Once diagnosed with heart valve disease, women have a 10% lower likelihood of appropriate transthoracic echocardiographic (TTE) surveillance than men7
Women with symptomatic severe AS were shown to be 20% less likely than men to receive AVR8
The undertreatment of AS is critical. Outcomes are directly impacted when patients are not referred to a Heart Valve Team sooner for evaluation9
AS is widely undertreated, and disparities exist across geography, care setting, and provider type.1-3
Even at Centers of Excellence, about 50% of patients with a class I or potential class IIa indication for AVR did not receive treatment(N=6150, 2000-2017)10
Nationwide network and data set show that nearly 60% of symptomatic severe AS patients did not receive treatment (N=6859, 2011-2016)11
Across 15 hospitals, almost 50% of symptomatic severe AS patients were untreated within 90 days post diagnosis according to registry data (N=1286, 2018-2020)9
Real world registry for 24 hospitals showed that ~40% of symptomatic severe AS patients were still untreated up to 4 years post diagnosis(N=12,129 2016-2022)12
ACCURATE ASSESSMENTS ENABLE LIFESAVING INTERVENTION13
Following echocardiography best practices could ensure optimal clinical decision-making for all patients with severe AS, regardless of subtype.
DETERMINING WHO IS RIGHT FOR TAVR
Give your patients a better chance of survival. Recognizing the broadened eligibility of TAVR—which includes low-risk symptomatic patients—can make a difference.
References:1.Tribouilloy C, Bohbot Y, Rusinaru D, et al. Excess mortality and undertreatment of women with severe aortic stenosis. J Am Heart Assoc. 2021;10(1):e018816.2.Ahmed Y, van Bakel PAJ, Hou H, et al. Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population. PLoS One. 2023;18(4):e0281811.3.Crousillat DR, Amponasah DK, Camacho, et al. Racial and ethnic differences in the clinical diagnosis of aortic stenosis. Am Heart Assoc. 2022;11(24):e025692.4.Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex disparities in cardiovascular disease. Methodist Debakey Cardiovasc J. 2024;20(2):107-119.5.Hervault M, Clavel MA. Sex-related differences in calcific aortic valve stenosis: pathophysiology, epidemiology, etiology, diagnosis, presentation, and outcomes. Structural Heart. 2018;2(2)102-113.6.Capoulade R, Clavel MA, Le Ven F, et al. Impact of left ventricular remodelling patterns on outcomes in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2017;18(12):1378-1387.7.Tanguturi VK, Bhambhani V, Picard MH, Armstrong K, Wasfy JH. Echocardiographic surveillance of valvular heart disease in different sociodemographic groups. JACC Cardiovasc Imaging. 2019;12(4):751-752.8.Lowenstern A, Sheridan P, Wang TY, et al. Sex disparities in patients with symptomatic severe aortic stenosis. Am Heart J. 2021;237:116-127.9.Lindman BR, Fonarow GC, Myers G, et al. Target Aortic Stenosis: a national initiative to improve quality of care and outcomes for patients with aortic stenosis. Circ Cardiovasc Qual Outcomes. 2023;16(6):e009712.10.Li SX, Patel NK, Flannery LD, et al. Trends in utilization of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2022;79(9):864-877.11.Brennan JM, Leon MB, Sheridan P, et al. Racial differences in the use of aortic valve replacement for treatment of symptomatic severe aortic valve stenosis in the transcatheter aortic valve replacement era. J Am Heart Assoc. 2020;9(16):e015879.12.Généreux P, Sharma RP, Cubeddu RJ, et al. The mortality burden of untreated aortic stenosis. J Am Coll Cardiol. 2023;82(22):2101-2109.13.Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: A focused update from the European association of cardiovascular imaging and the American society of echocardiography. J Am Soc Echocardiogr. 2017;30(4):372-392.
Patients and/or clinicians quoted on this website have received compensation from Edwards Lifesciences.
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TAVR by Edwards is now the FIRST and ONLY TAVR to be approved for the treatment of both symptomatic and asymptomatic patients with severe aortic stenosis, also known as heart valve failure.
