Treatment bias may explain the underutilization of valve surgeries for infective endocarditis (IE) in women, according to new data published in the Journal of the American Heart Association.
“The salient finding is that female sex was associated with a decreased likelihood of undergoing overall cardiac valve replacement,” wrote lead author Agam Bansal, MD, with the department of cardiovascular medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, and colleagues. “However, the lower rates of surgery in women did not translate into higher observed in‐hospital mortality. Women selected to undergo surgery had significantly higher in‐hospital mortality rates than their male counterparts. The overall rates of surgery for endocarditis rose during the period of observation but there continued to exist a gap between the two sexes. Finally, although in‐hospital mortality rates for IE surgery decreased during the study period, women continued to experience higher in‐hospital mortality.”
Researchers analyzed 81,942 hospitalized patients with a primary diagnosis of infective endocarditis from January 2004 to September 2015. Forty-four percent of patients were women.
Data is from Agency for Healthcare Research and Quality's National Inpatient Sample (NIS).
The primary end point of the study was cardiac valve replacement in patients hospitalized with IE.
In the analysis, women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%, aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%), tricuspid valve replacement (0.32% versus 0.36%), tricuspid valve repair (0.63% versus (0.65%).
The authors found that in-hospital mortality rates were similar.
The overall rates of cardiac valve replacement rose from 11.76% to 13.96% in men and 6.34% to 9.26% in women while in‐hospital mortality declined in both men and women between 2004 to 2015.
In addition, the overall in‐hospital mortality rates were substantially higher in women who had valve replacement surgery in comparison to men, 9.94% versus 6.99% respectively.
“In line with previous investigations, more women hospitalized with IE should be offered early surgical intervention. It is encouraging to find that the rates of valve replacement surgeries have increased from 2004 to 2015 and more importantly, the gap in the in‐hospital mortality rates between men and women has narrowed over the mentioned time-period,” the authors wrote.
Read the entire study here.