The article is in partnership with Edwards Lifesciences, issued in public interest for creating awareness about aortic stenosis.
In 2023, Priya (name changed), 72, a resident of Mumbai, found herself in a battle with an unexpected enemy — her heart. What began as vague symptoms — loss of appetite and an overall feeling of unease — soon spiralled into something much more serious. She also experienced pain in the chest along with difficulty in breathing. She was later diagnosed with aortic stenosis — a condition where blood flow is decreased due to the narrowing of the aortic valve.
“I felt anxious when I first heard the diagnosis. So many questions ran through my mind, but the uncertainty was the hardest to bear,” she recalls. A delayed diagnosis had increased the severity of the disease for Priya.
While aortic stenosis (AS) affects millions worldwide, women are more likely to be misdiagnosed or underdiagnosed. As per a 2019 study, women are 13% less likely to be referred and 20% less likely to receive timely treatment compared to men.
“Women may attribute early symptoms of aortic stenosis, such as breathlessness, fatigue, or mild difficulty climbing stairs, to other causes like overexertion, stress, or even their menstrual cycles,” says Dr Rohit Singh, senior director of medical affairs at Edward Lifesciences. This, he explains, often leads to a delay in diagnosis and treatment.
Some common symptoms women should look out for include:
● Shortness of breath (dyspnea): This is a common symptom, especially during physical activity. You might feel like you can’t catch your breath or that you need to stop and rest frequently.
● Chest pain or tightness (angina): This can feel like pressure, squeezing, or a burning sensation in the chest, often brought on by exertion.
● Fatigue: Feeling unusually tired or weak, especially after activity.
● Dizziness or fainting (syncope): Feeling lightheaded, dizzy, or even passing out, particularly during or after exercise.
● Heart palpitations: Feeling like your heart is racing, fluttering, or skipping beats.
● Decreased exercise tolerance: Not being able to do as much physical activity as you used to without feeling tired or short of breath.
● Swollen ankles or feet: This can be a sign of heart failure, which can be a complication of aortic stenosis.
Underrepresentation of women in heart disease research
The RHEIA trial is the first dedicated randomised TAVI trial in women, which showed TAVI superiority over surgery, particularly with respect to reducing the number of repeated hospitalisations, thereby also having a clear health and economic benefit. The RHEIA trial shows that for women with severe symptomatic aortic stenosis, TAVI using balloon-expandable devices could be considered the preferred therapy.
“If you pick any gold standard trial related to heart health, or I would say related to any form of disease, you will always see women are less represented. There probably be a 70-30 mix of patients, with 70% being men,” says Dr Rohit Singh.
This gap has serious consequences. “Women often experience higher pressures in the heart despite having the same severity of conditions like aortic stenosis. This makes their diagnosis and treatment more complicated,” Dr Rohit Singh explains.
“For the same valve area (the opening through which blood flows), women often experience higher pressures than men. For example, both a man and a woman might have an aortic valve area of 1.2 square centimeters, However, the pressure required to push blood through that opening will likely be higher in the woman. While the progression of the disease (how quickly the valve deteriorates) might be similar between men and women, the higher pressures in women mean their hearts are working harder from the start,” he adds.
Elaborating more on the trial, Dr Rohit Singh says that the study had two basic arms. “One group of women received TAVR (transcatheter aortic valve replacement), while the other received SAVR (surgical aortic valve replacement). It shows that the women patients who received TAVR got a much better outcome and a much better prognosis, as compared to surgical arms.”
“It clearly shows that even for women, with the right intervention and approach, the outcomes are equal, or superior, to what outcome would predominantly be for men,” he adds.
Dr Rohit Singh believes that this research is just a beginning towards understanding women’s heart health better. “While we have multiple groundbreaking studies on our Edwards TAVI technology. It’s a starting point. This study creates momentum for more women-centric research and will encourage clinicians and investigators to view women as a distinct population, rather than simply including them in studies primarily focused on men,” he says.
TAVR vs SAVR: What’s the difference?
TAVR, short for transcatheter aortic valve replacement, is a procedure that replaces a faulty aortic valve in the heart using a catheter inserted into the blood vessel on a patient’s upper leg or chest. It is also called a transcatheter aortic valve implantation or TAVI. SAVR, on the other hand, stands for surgical aortic valve replacement and involves an open surgery.
“Both are currently established for a treatment of aortic stenosis,” Dr Rohit Singh says, explaining that the choice of treatment is dictated by a set of guidelines that have clear-cut recommendations on who should get surgery and who should get a transcatheter valve. The main criterion for deciding the form of treatment, often, remains age.
“If the patient has no major risk criteria and the patient is less than 65, then surgery is recommended. Similarly, if the patient is over 80 and does not have any risk factors, then transcatheter is recommended. Between the ages of 65 and 80, choice of therapy is decided based on patients condition and heart team recommendations” Dr Rohit Singh says.
The heart team is a multi-disciplinary team, which includes a surgeon, a cardiologist, an anesthetist, an imaging person, a nurse, and a sonographer.
“So if the patient is between 65 to 80, he or she can go for any form of treatment, but it is decided by the heart team as to whether surgery or transcatheter would be better for the patient over the long term,” Dr Rohit Singh informs.
Before her doctors introduced her to TAVI, Priya’s options were limited. The prognosis for untreated aortic stenosis could have led to heart failure, or worse, a sudden fatal event.
“I was anxious about the procedure at first. It was new to me,” Priya admits. “But with the doctor’s reassurance, I felt more confident in the decision.” The change was transformative.
“Before the procedure, I was dealing with constant breathlessness, fatigue, and anxiety about my heart. Now, with my new valve, I feel like a weight has been lifted,” she adds.
A minimally invasive option that could be performed on patients who face high risks during surgery, TAVI remains a breakthrough for several people. The RHEIA trial found out that TAVI was associated with a lower rate of new-onset atrial fibrillation and shorter hospitalizations.
Looking ahead: A future of inclusive healthcare
The challenges women face with aortic stenosis often create a vicious cycle. The reasons are complex, but the consequences are clear: delayed treatment, delayed diagnosis, and a disparity in care.
In a country like India, where heart disease is one of the leading causes of death among women, the RHEIA trial opens the doors for a more non-invasive approach to understanding the specifics of women’s heart health.
“More women-specific research will create a clearer picture of how heart disease affects women, how their bodies respond to treatment, and ultimately, how we can provide them with the best possible care. We need data-driven insights, not assumptions. This study is a crucial first step in that direction,” says Dr Rohit Singh.
“The key message is that women are unique, not just socially, but biologically as well. We can’t afford to rely on assumptions based on male-centric research. In this era of advanced technology, we shouldn’t remain in the dark about women’s health,” he adds.
“If there’s one thing I want other women to know, it’s this: don’t wait. If you experience any chest pain, discomfort, or breathlessness, seek help immediately,” says Priya. “We need to take our health seriously because it can make all the difference.”
Information appearing in this material is for general disease and therapy awareness only. Nothing contained in this material constitutes medical advice. Please consult your doctor for medical advice or any question or concern you may have regarding your health condition.
Edited by Leila Badyari Castelino
