Gender differences in clinical profiles, management and outcomes of valvular heart disease in China: insights from a nationwide cohort.

Women represented nearly half of the nationwide VHD cohort and had a higher burden of rheumatic disease while men had more degenerative and functional VHD.

• A total of 13,917 adult patients with moderate-to-severe VHD were enrolled between April and June 2018 across 46 tertiary hospitals in China.
• Of these, 6,296 (45.24%) were women.
• Women had more rheumatic VHD, while men had more degenerative and functional VHD.
• The study was a nationwide, prospective, multicentre cohort study (NCT03484806).

The overall intervention rate was 31.72% with no significant gender difference between men and women.

• Men had an intervention rate of 31.26% versus 32.27% for women.
• Among the 5,427 patients with severe symptomatic VHD, 49.11% received interventional therapy.
• Patients received either conservative therapy or valve interventions, including surgical repair/replacement or transcatheter procedures.

Women with severe symptomatic multiple valvular heart disease had a higher propensity for intervention compared to men.

• The sex-specific pattern was statistically significant in severe symptomatic multiple valvular heart disease (p<0.001).
• The odds ratio for women receiving intervention in this subgroup was 1.19–1.66.
• This represented a notable exception to the otherwise equivalent intervention rates between sexes.

Women with severe symptomatic aortic regurgitation were less likely to receive valve replacement than men.

• The difference was statistically significant (p=0.03).
• The odds ratio for women receiving valve replacement in severe symptomatic aortic regurgitation was 0.39–0.95.
• This finding suggests a sex-specific disparity in management of this particular VHD subtype.

The 2-year all-cause survival rate was 90.85% with no significant gender difference.

• Men had a 2-year survival rate of 90.41% versus 91.38% for women (p=0.086).
• Multivariate Cox regression confirmed no significant gender effect on survival (p>0.05).
• Outcomes assessed included 2-year all-cause mortality, cardiovascular mortality, heart failure hospitalisation, and major adverse cardiovascular events.

Valve intervention was associated with improved 2-year survival with no gender disparity in survival benefit.

• Valve intervention improved survival to 97.0% overall.
• Men who received intervention had a survival rate of 96.92% versus 97.01% for women (p=0.87).
• No gender disparity was observed in the survival benefit conferred by valve intervention.

Age and VHD subtype were identified as factors influencing intervention rates and prognosis.

• Multivariable Cox and logistic regression analyses were conducted to identify outcome predictors.
• Age and VHD subtype influenced both intervention rates and prognosis.
• The authors concluded that findings support individualised, sex- and age-stratified management strategies.