Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions

Sonya Burgess; F Aaysha Cader; Elizabeth Shaw; Shrilla Banerjee; Julia Stehli; Roopa Krishnamorthy; Lynn Khor; Homa Forotan; Alexandra Bastiany; Sarita Rao; Jaya Chandrasekhar; Sarah Zaman; Mirvat Alasnag; Alaide Chieffo; Megan Coylewright

doi:10.15420/ecr.2022.33

Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions

Eur Cardiol. 2022 Dec 19:17:e27. doi: 10.15420/ecr.2022.33. eCollection 2022 Feb.

Authors

Sonya Burgess^{1

2}, F Aaysha Cader^{3

4}, Elizabeth Shaw^{1

5

6}, Shrilla Banerjee⁷, Julia Stehli⁸, Roopa Krishnamorthy², Lynn Khor², Homa Forotan⁹, Alexandra Bastiany¹⁰, Sarita Rao¹¹, Jaya Chandrasekhar^{12

13}, Sarah Zaman^{14

15}, Mirvat Alasnag¹⁶, Alaide Chieffo¹⁷, Megan Coylewright¹⁸

Affiliations

¹ Department of Medicine, University of Sydney Sydney, New South Wales, Australia.
² Department of Cardiology, Nepean Hospital Sydney, New South Wales, Australia.
³ Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute Dhaka, Bangladesh.
⁴ Department of Population Health, University of Oxford Oxford, UK.
⁵ Department of Cardiology, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia.
⁶ Department of Cardiology, Sydney Adventist Hospital, Wahroonga Sydney, New South Wales, Australia.
⁷ Department of Cardiology, Surrey and Sussex Healthcare NHS Trust Redhill, UK.
⁸ Department of Cardiology, University Hospital Zurich Zurich, Switzerland.
⁹ Department of Cardiology, Princess Alexandra Hospital Brisbane, Queensland, Australia.
¹⁰ Thunder Bay Regional Health Sciences Centre and Northern Ontario School of Medicine Thunder Bay, Ontario, Canada.
¹¹ Department of Cardiology, Apollo Hospital Indore, India.
¹² Department of Cardiology, Eastern Health Melbourne, Victoria, Australia.
¹³ Eastern Health Clinical School, Monash University Melbourne, Victoria, Australia.
¹⁴ Westmead Applied Research Centre, University of Sydney Sydney, New South Wales, Australia.
¹⁵ Department of Cardiology, Westmead Hospital Sydney, New South Wales, Australia.
¹⁶ Department of Cardiology, King Fahd Armed Forces Hospital Jeddah, Saudi Arabia.
¹⁷ Interventional Cardiology Unit, San Raffaele Scientific Institute Milan, Italy.
¹⁸ Section of Cardiovascular Medicine, Erlanger Heart and Lung Institute Chattanooga, Tennessee, US.

Abstract

Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.

Keywords: Women; interventional cardiology; structural interventions; transcatheter aortic valve replacement; transcatheter mitral valve repair; workforce.

Publication types

Review