Waiting Times of Women versus Men Undergoing Transcatheter Aortic Valve Implantation.

Abstract

Increasing transcatheter aortic valve implantation (TAVI) rates have resulted in prolonged waiting times. These have been associated with heart failure hospitalisations (HFH) and mortality yet sex differences have not yet been reported. All patients who underwent TAVI for severe aortic stenosis at a tertiary referral hospital in Australia were prospectively included. Total waiting time was divided into 'work-up' waiting time (period from referral date until heart team approval) and, 'procedural' waiting time (period from heart team approval until procedure date). Patients were analysed according to sex. Cohorts were matched to correct for differences in baseline and procedural variables. The primary endpoints were waiting times. Secondary outcomes included a composite of 30-day mortality and HFH, quality of life and mobility. A total of 407 patients (42% women) were included. After matching of the two cohorts (345 patients), women had significantly longer total waiting times than men: median 156 [interquartile range (IQR) 114-220] days in women versus 147 [IQR 92-204] days in men (p=0.032) including longer work-up (83 [IQR 50-128] versus 71 [IQR 36-119], p=0.195) and procedural waiting times (65 [IQR 44-100] versus 58 [IQR 30-93], p=0.021). Increasing waiting times were associated with higher 30-day mortality and HFH (p=0.01 for work-up waiting time, p=0.02 for procedural waiting time) and decreased 30-day mobility (p=0.044 for procedural waiting time) in women, but not in men. TAVI waiting times are significantly longer in women compared to men and are associated with increased mortality and HFH and reduced mobility at 30-days.