Few TAVI Doctors Are Women, With No Female Operators in 19 States

Women continue to be underrepresented among TAVI operators despite increased awareness of the gender imbalance, according to a new research letter. Notably, 19 US states had no female operators in 2018.

Over the past few years, programs like the Society for Cardiovascular Angiography and Intervention’s Women in Innovations (WIN) and the American College of Cardiology’s Women in Cardiology (WIC) section have been encouraging women to enter the field of interventional cardiology, and gender disparities have seemed to gain more attention across the spectrum of cardiology fields, senior author Harsh Golwala, MD (Oregon Health and Science University, Portland), told TCTMD.

Yet they still remain, with women facing added workplace pressures and fewer women contributing to cardiology research.

“I wanted this paper to set a baseline of what we are looking at in 2018 so that as we push for all these initiatives, we can demonstrate how are we trying to improve our field over the next decade,” Golwala said.

Many patients prefer female proceduralists, he continued, and encouraging women to join the field “may lead to diversification in clinical trial enterprise in the future, with a final goal of closing the gender gap in clinical trial leadership and enrollment.”

Representation Consistently Low

For their study, published online this week ahead of print in Circulation: Cardiovascular Interventions, the researchers, led by Timothy F. Simpson, MD, PharmD (Oregon Health and Science University, Portland), used Medicare data to identify 1,806 operators (3.9% female) who performed more than 10 TAVI procedures in 2018.

Women made up a smaller proportion of interventional cardiologists compared with cardiac surgeons (2.7% vs 5.1%; P = 0.009). And while the authors noted that the number of TAVI operators rose overall from 320 in 2014 to 1,806 in 2018—representing a 58.7% annualized increase—the proportion of female operators did not reflect the same gains, rising from 2.5% to just 3.9%. Also, there were no differences seen in median annual procedural volume between women and men over the same time period.

No female operators were listed in 19 of 50 US states in 2018, and female representation was consistently low across all regions.

Attendance of women in US medical schools is increasing, and cardiology in particular is becoming “better and better” at attracting more women, Golwala said. “I think the next step is to try to do this in the procedural field, which is interventional cardiology or cardiac surgery.”

To make this happen, he continued, “we need to work with the societies to increase the awareness and more importantly also reduce the anxiety which comes along with the lifestyle and the stress of the specialty. Those can be overcome by mentorship with support and creating a culture which supports everyone to acquire skills and be leaders in the field.”

A range of recent studies have highlighted the lack of female lead and senior authors in cardiovascular trials and publications, with several cardiology leaders pointing out that women choosing a career path in medicine may be dissuaded from pursuing cardiology if the literature hints that there are fewer opportunities to lead.

To this point, Golwala acknowledged the lack of either a female first or last author on his own study, saying “everyone should contribute” to research in this space: “We should all work together for equality.”