Medtronic survey finds older women face gap in awareness of and screening for aortic stenosis

Aortic stenosis, also known as heart valve disease, typically occurs later in age as the aortic valve thickens and narrows, weakening the heart as it’s forced to work harder to pump blood throughout the body.

Though men are more likely to develop the condition, studies have shown that when it comes to severe cases, women—who are often older and more symptomatic than their male counterparts when they’re diagnosed—have a higher mortality rate, even after controlling for the age differences.

Results of a survey recently commissioned by Medtronic, in partnership with women’s heart health-focused nonprofit Women as One, suggest that a lack of awareness could be at least partially to blame for those heightened risks for women.

The survey included 1,000 racially diverse U.S. women aged 50 and older, according to a Medtronic release this week. While around three-quarters knew of several of the most common heart diseases, only 30% reported having heard of AS—and those numbers were significantly lower among Black and Hispanic women, only 10% and 21% of whom, respectively, had heard of the condition.

Doctors, too, seem to be somewhat unaware of the prevalence and risks of AS among women. The survey found that more than 80% of women over 65 have a chronic condition that could up their chances of developing AS, but less than a third of them have ever been referred to a cardiologist or undergone a heart disease risk assessment.

That lack of care for the condition could also come down to women’s worries around doctor visits: More than 40% of those surveyed said the fear or anxiety they associate with going to the doctor would stop them from seeking medical care for symptoms like fatigue and shortness of breath, and 15% reported feeling like their symptoms would be dismissed if they did talk to a doctor.

“When compared to male patients, female patients often present with more advanced symptoms of heart valve disease highlighting the importance of uncovering how we can best educate women on early warning signs and treatment options sooner,” Roxana Mehran, M.D., co-founder and president of Women as One, said in the release. “These survey findings grant us the opportunity to develop better partnerships with communities experiencing the most inequities and provide a pathway to refining policies and systems that will lead to better care.”

So far, that pathway includes awareness-raising campaigns and women-focused clinical trials launched by Medtronic, Women as One and their other partners.

On the trial front, Medtronic timed the release of the survey results to a presentation Sunday at the American College of Cardiology’s annual scientific session, during which it unveiled one-year results from its SMART trial studying the treatment of severe AS in patients with small annuli, a patient population made up primarily of women. Nina Goodheart, president of structural heart and aortic at Medtronic, described the study as the company’s “latest effort to address the underrepresentation of women in cardiovascular health research.”

The study compared Medtronic’s Evolut transcatheter aortic valve replacement (TAVR) system to Edwards Lifesciences’ Sapien system among more than 700 patients, almost 90% of which were women, and found that the Evolut device was noninferior to Sapien in its rate of post-implant mortality, stroke and heart failure rehospitalization, while outperforming Sapien in how well the replacement valve functioned after one year.

Howard Herrmann, M.D., lead investigator of the SMART trial, noted in the study release, “While we know women have a greater benefit than men when treated with TAVR vs [surgical aortic valve replacement], now for the first time there is definitive data demonstrating that women have the best valve performance when treated with the Evolut TAVR system.”

Meanwhile, in the survey, Medtronic made sure to ask respondents about their preferred treatments for AS. Nearly half said a minimally invasive option would be preferable—“highlighting the importance of solutions like TAVR,” per Medtronic—and three-quarters said they would be “very” or “extremely” likely to ask about a treatment option that had been proven to be more effective in women than one their doctor had initially recommended, further underlining the recent study results.