Proportion of Women Undergoing TAVI for Aortic Stenosis Declining in US

Why It Matters

The shrinking proportion of women receiving TAVI highlights a gender gap that could worsen outcomes for a high‑risk cohort and signals the need for equitable cardiovascular care policies.

Key Takeaways

• Female TAVI share fell 4 percentage points over decade
• Women face 20% higher periprocedural mortality than men
• Vascular and bleeding complications are markedly higher in women
• Referral bias and anatomy may limit women's TAVI utilization

Pulse Analysis

The adoption of transcatheter aortic valve implantation has accelerated across the United States, yet a new JAMA Cardiology analysis reveals a subtle but concerning shift in gender balance. Between 2013 and 2022, Medicare beneficiaries saw overall TAVI volumes rise dramatically, but the proportion of female patients dropped from nearly half to just under 44 percent. This decline cannot be explained by differences in disease prevalence, suggesting systemic factors are influencing who receives the life‑saving procedure.

Clinical outcomes further underscore the disparity. Women undergoing TAVI faced a 20 percent higher adjusted odds of periprocedural death and significantly greater rates of vascular injury and bleeding, likely linked to smaller vessel size and distinct aortic valve anatomy. Paradoxically, long‑term survival at six years was modestly better for women, though they endured higher rates of heart‑failure hospitalization, stroke, and myocardial infarction. These mixed results point to a complex risk profile that may deter clinicians from referring female patients, reinforcing existing biases.

Addressing the gap will require both research and policy action. Experts propose sex‑specific diagnostic thresholds and tailored device sizing to mitigate procedural complications. Moreover, qualitative studies of referral patterns could expose hidden biases within heart teams. As the cardiovascular field moves toward precision medicine, ensuring equitable access to TAVI for women will be essential to improve outcomes and close the gender gap in cardiac care.