Perspectives of Interventional Cardiologists and Cardiothoracic Surgeons on the Late Diagnosis and Undertreatment of Women Diagnosed with Severe Symptomatic Aortic Stenosis

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Abstract
Background: The prevalence of severe symptomatic aortic stenosis (sSAS) continues to rise, yet women remain significantly less likely to receive timely intervention. Evidence indicates a 36% lower likelihood of diagnosis and a 20% lower likelihood of undergoing aortic valve replacement (AVR) compared with men. The purpose of this study was to examine the perspectives of interventional cardiologists and cardiothoracic surgeons who treat AS about late diagnosis and undertreatment of women with sSAS. Methods: A cross-sectional, web-based survey was distributed to interventional cardiologists and cardiothoracic surgeons across the United States. Participants completed a 10-item open-ended questionnaire developed from published literature. Responses were analyzed using descriptive statistics and qualitative content analysis to identify key issues related to diagnostic practices, referral patterns, and provider perceptions. Results: Nineteen physicians completed the survey (15% response rate). While most participants believed women receive timely AVR consistent with guidelines, they acknowledged delays due to multifactorial causes, including under-recognition of symptoms, diagnostic variability in community echocardiography practices, limited awareness of sex-specific guideline gaps, and socioeconomic barriers such as financial constraints, caregiver burden, and access to care. Although some respondents denied overt gender bias, others described subtle or unconscious bias influencing referral timing and symptom interpretation. Conclusions: Survey respondents recognized complex clinical and systemic factors contributing to delayed diagnosis and undertreatment of women with sSAS. Enhanced provider education, improved access to diagnostic testing, and revision of sex-specific clinical guidelines are needed to promote equitable care and timely intervention for female patients.

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