Sepsis remains a leading cause of preventable morbidity and mortality worldwide, and adherence to the Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) remains modest and variable across institutions. Simultaneously, controversy persists regarding fixed-volume fluid resuscitation mandates, particularly given the increasing emphasis on individualized, physiology-guided management. Artificial intelligence (AI) has emerged as a potential strategy to address both operational and clinical gaps in sepsis care. This review examines the current state of SEP-1 implementation, key barriers to compliance, and ongoing debates surrounding early fluid administration. We then discuss contemporary evidence on AI-enabled tools designed to accelerate bundle processes and support personalized fluid management. Early warning systems, natural language processing-augmented models, and telemedicine-integrated platforms have demonstrated improvements in process measures such as time-to-antibiotics and bundle component completion when embedded within defined clinical workflows. Reinforcement learning, causal machine learning, and predictive models offer promise for individualized fluid strategies, although most data remain retrospective and hypothesis-generating. Successful integration will require prospective validation, clinician-in-the-loop oversight, governance frameworks, and continuous monitoring for safety, equity, and model drift. AI should augment-rather than replace-clinical judgment to improve reliability, timeliness, and personalization in sepsis management.
Despite a wide adoption of observation status policy for Medicare beneficiaries with diverse conditions across U.S., little is known about population-level changes in observation status use for children. This study aimed to examine statewide trends in observation status use for pediatric population. This repeated cross-sectional analysis used statewide hospital discharge data from six states from 2012 through 2019 to characterize inpatient and observation stays for patients <18 years old with conditions that may require short-term hospital stay (i.e., <3 days). The population-level use of observation status was measured by observation stay rate, defined as the number of observation stays per 100,000 children per year for each state. Population-level changes were examined using linear regressions with generalized estimating equations to account for within-state clustering. Subgroup analyses were conducted by patient demographics, neighborhood socioeconomic characteristics, diagnosis groups, chronic condition status, and length of stay. Among 808,181 hospital stays, 299,483 (37.1%) were observation stays. From 2012 through 2019, observation stay rates increased in all six states, with an average annual growth of 17.8 (95% Confidence Interval (CI): 10.4-25.3) per 100,000 children. Observation stay rates significantly increased for children who were <6 years old, non-White, and publicly insured. Red blood cell disorders had the fast-growing use of observation status, with a percentage increase of 25.7% (95%CI: 18.6%-33.3%). Although descriptive, we found substantial yet differential increases in observation-status use among children, especially for younger, non-White, publicly insured children and for conditions previously cared under an inpatient designation, using multi-state population-level data.
Atrial fibrillation (AF) has roughly tripled in prevalence over the last 50 years. This disease disproportionately affects morbidity and mortality among older women. Increased physical activity has been associated with lower incidence of new AF in some studies, but higher incidence in others, especially among elite athletes. We designed a randomized trial within the Women's Health Initiative (WHI) Strong and Healthy (WHISH) trial to test the hypothesis that a pragmatic intervention consisting of multimodal messaging recommending physical activity levels consistent with national guidelines would decrease the incidence of AF among a cohort of older women. The present WHISH Silent Atrial Fibrillation Recording (WHISH STAR) trial randomized 29,758 postmenopausal women without baseline AF who were enrolled in Medicare Fee-for-Service to the aforementioned intervention or comparison group, with planned 7-year follow-up to assess the primary outcome of incident clinical AF, namely those identified in Medicare claims. We also designed a sub-study of 1,257 women at high risk for AF (with a CHARGE-AF score ≥ 5%) to undergo serial, 7-day ECG patch monitoring to detect screened AF. We will use Cox proportional hazards models to compare the incidence of clinical AF in the participants assigned to physical activity intervention and the participants assigned to usual care groups. We will also compare the incidence of screened AF in the intervention and comparison groups detected on patch ECG monitors in the sub-study of women who underwent serial ECG patch monitoring. The WHISH STAR trial will rigorously evaluate of the effect of a pragmatic physical activity intervention on the development of AF in a large, diverse, well-characterized cohort of older women. The WHISH trial is embedded within the nationwide WHI study, enrolling postmenopausal women from 40 US clinical centers. Participants were enrolled in 2015 per the parent WHISH trial. WHISH STAR is in the analysis phase. WHISH STAR has been registered on www. gov (NCT05366803).
Allergic diseases are an increasing public health concern among Australian children, with notable inequalities in healthcare utilization. This study examined how early socioeconomic status (SES) influences healthcare use for childhood allergic diseases, mediated by parenting style and parental relationship quality. Using data from a nationally representative longitudinal cohort, meditational analyses were conducted with a time-lagged design. Generalized structural equation modeling with a negative binomial family and logit link estimated direct and indirect effects. Statistical significance was defined as p < 0.05 or 95% bootstrapped confidence intervals excluding zero. Allergic disease prevalence was 23.3% and 55% of affected children had high healthcare utilization. Higher SES was indirectly associated with increased healthcare use through parenting style (IRR = 1.27, p < 0.05) and parental relationship quality (IRR = 1.91, p < 0.05). Sequential mediation was significant (IRR = 1.29, p < 0.05), with a strong total indirect effect (IRR = 2.07, p < 0.05) and a substantial overall total effect (IRR = 2.44, p < 0.05). Parenting style and parental relationship quality partially mediate the SES-healthcare utilization relationship. Strengthening family dynamics alongside addressing socioeconomic inequities will improve equitable healthcare access for children with allergic diseases.
Use of digital communication tools (e.g., telehealth, patient portals) is increasing in outpatient palliative care (OPC). Assess patient/caregiver experiences with digital communication tools. Qualitative. Inclusion criteria were age ≥18 years, English/Spanish/Cantonese-speaking, and ≥1 telehealth OPC visit in the prior year. If patients could not converse by phone, we interviewed their caregivers. We developed an interview guide using the Capability-Opportunity-Motivation-Behavior framework. We analyzed semi-structured interviews using thematic analysis. Among 32 participants, 10 were caregivers, 11 Spanish-speaking, 9 Cantonese-speaking. Theme 1: Video and in-person visits have important and distinct roles. Theme 2: Establishing a trusting rapport over video is possible. Theme 3: Engagement can be high with the patient portal despite poor usability. A flexible approach offering both video and in-person visits is ideal. Usability is a key factor in patient portal engagement. Our findings underscore the need to advocate for a permanent Medicare telehealth extension.
A convenience sample of doctors working in UCCs since 1 July 2023 were invited to participate in an online survey. This was advertised through The Royal Australian College of General Practitioners (RACGP), The Royal New Zealand College of Urgent Care (RNZCUC), corporate general practices, UCC peer groups and LinkedIn.  RESULTS: A convenience sample of doctors working in UCCs since 1 July 2023 were invited to participate in an online survey. This was advertised through The Royal Australian College of General Practitioners (RACGP), The Royal New Zealand College of Urgent Care (RNZCUC), corporate general practices, UCC peer groups and LinkedIn.  DISCUSSION: Findings were compared with practices in other Western countries. This study highlights the potential for national standards to address unwarranted variation in health care delivery in Australian UCCs.
Breast cancer is the most prevalent and costly cancer. Oral endocrine therapy (OET) improves survival rates and quality of life while reducing recurrence, mortality, morbidity, and medical costs. However, adherence to OET is challenging because OET is prescribed for 5-10 years. Determinants of OET nonadherence (NA) among women aged 65 and older remain poorly characterized. Existing studies are limited, often focusing on small, single-site samples and focusing on patient-level rather than multi-level determinants. Despite the unique needs of older women, research on OET-NA remains scarce. This study identified multi-level determinants of OET-NA in older women using ecological systems theory and the World Health Organization's five-dimension model. A descriptive, correlational secondary data analysis was conducted using the 2019 Surveillance-Epidemiology-End-Results (SEER) Medicare database, which includes more than 9 million cancer cases in the United States. OET-NA was significantly affected by (a) patient-related factors of ethnicity (i.e., Black [AOR 1.55; 95% CI 1.34-1.78; p < 0.001]) and psychological issues (i.e., depression [OR 1.40; 95% CI 1.27-1.54; p < 0.001]), (b) socioeconomic-related factors of marital status (i.e., divorced [OR 1.17; 95% CI 1.04-1.32; p ≤ 0.01]), and lifestyle (i.e., tobacco use [OR 1.41; 95% CI 1.22-1.63; p < 0.001]), (c) therapy-related factors of switching OET medications (OR 2.72; 95% CI 2.41-3.07; p < 0.001), (d) condition-related factors of comorbidities (i.e., obesity [OR 1.13; 95% CI 1.03-1.23; p < 0.01]), and (e) characteristics of the healthcare team and health system-related factors (i.e., group practice type [OR 1.26; 95% CI 1.01-1.56; p < 0.05]). OET-NA was associated with multi-level determinants, including being Black, having depression, being divorced, using tobacco, switching OET medications, having obesity, and receiving care in group practices. Identifying these determinants is a critical first step toward developing and testing interventions to improve OET-NA and enhance survival and quality of life.
With aging, left ventricular (LV) early diastolic lengthening declines. Delayed or dyssynchronous untwisting and relaxation may slow and reduce filling and contribute to elevated diastolic pressures. Segmental variations in the timing of early diastolic relaxation may impair LV suction during exercise and impact LV stroke volume reserve, especially in heart failure with preserved ejection fraction (HFpEF). To determine possible mechanisms causing dyspnea, we investigated 106 subjects aged ≥60 years, including 38 patients with HFpEF, and 26 breathless, 19 hypertensive, and 23 healthy controls, at rest and during submaximal exercise stress echocardiography. Global and regional early diastolic function were assessed by LV isovolumic relaxation time (IVRT), the deceleration time (DT) and propagation velocity of mitral inflow, and segmental variations in times to peak early diastolic myocardial velocity (e'). Global IVRT and DT were similar between groups at rest and during stress. During exercise, increments in mean segmental e' were similar between groups while times to peak e' shortened variably, being 13-20% longer in the mid-septal and 30-35% longer in the mid-lateral segments in HFpEF than in healthy or hypertensive subjects (p<0.001). There were moderate inverse correlations between time to peak e' and LV inflow velocity, cardiac output on exercise, and 6-minute walk distance (ρ -0.42, p<0.001). Slower early diastolic relaxation on exercise is associated with less stroke volume reserve and reduced exercise capacity. Machine learning might be able to identify subtle changes in timing of relaxation as a diagnostic or therapeutic target in subjects with HFpEF.
Randomized trials evaluating multiarterial grafting (MAG) vs single arterial grafting (SAG) during coronary artery bypass grafting (CABG) have not demonstrated a long-term survival benefit, whereas conventional retrospective studies have consistently reported improved survival with MAG. Whether this discordance reflects true treatment effect heterogeneity or bias from unmeasured confounding in observational analysis remains unclear. Our objective was to evaluate whether the apparent survival advantage associated with MAG in conventional observational analyses persists after accounting for unmeasured confounding using a quasi-experimental instrumental variable (IV) approach and to assess the implications of these findings for long-term survival in an older Medicare population. We retrospectively analyzed Medicare beneficiaries who underwent CABG from 2001 to 2019. Surgeon MAG rate during the 12 months preceding each operation was leveraged as an IV. Flexible parametric survival models with time-dependent effects were developed with MAG vs SAG as the exposure variable. The non-IV model adjusted for patient demographics, pre-existing comorbidities, hospital and surgeon characteristics, and procedural details. The IV model incorporated these same covariates plus the IV (surgeon MAG rate) using a 2-stage residual inclusion approach. Regression standardization was used to derive standardized survival probabilities and their differences. Among 1,291,314 beneficiaries, 1,145,760 (88.7%) underwent SAG and 145,554 (12.3%) underwent MAG. In the non-IV model, MAG recipients had improved risk-adjusted median survival as compared with SAG recipients: 10.74 years (95% CI: 10.70-10.79 years) vs 10.33 years (95% CI: 10.31-10.35 years), a difference of 0.41 years. Across 4,164 surgeons, the MAG rate during the 12 months preceding the index CABG was 7.7% ± 9.5% in SAG recipients and 32.9% ± 25.8% in MAG recipients. In the IV model, MAG recipients had similar risk-adjusted median survival compared with SAG recipients: 10.38 years (95% CI: 10.29-10.48 years) vs 10.38 years (95% CI: 10.35-10.40 years), a difference of 0.01 years. MAG was associated with a modest improvement in long-term survival in a conventional risk-adjusted analysis. However, this association was not robust to a quasi-experimental analysis in which surgeon MAG rate was incorporated as an IV to address unmeasured confounding. The contrast between these models suggests that traditional observational studies may overestimate the survival benefit of MAG because of unmeasured or difficult-to-measure patient characteristics that influence a surgeon's decision to offer MAG.
Vertically integrated health systems are expanding across the U.S., but there is no evidence that system-affiliated providers are better able to reduce socioeconomic disparities than unaffiliated providers. This paper develops and interprets statistical models for estimating the longitudinal effects of an exposure, health system affiliation, on within- and between-group disparities. Mixed effect difference-in-differences regression models were used to estimate the effect of physician organization (PO) health system affiliation on socioeconomic disparities in diabetes medication adherence for fee-for-service Medicare beneficiaries from 2013 to 2019, decomposing the effect of affiliation on disparities into within- and between-PO socioeconomic disparities. We find that after becoming affiliated, adherence for dually-eligible beneficiaries worsened relative to non dually-eligible beneficiaries within POs, but between-PO disparities were reduced. Simulation studies were used to evaluate the methods, and showed the importance of centering dual-eligibility status and its interaction with affiliation status at the PO-year level and including the PO-year level means as predictors to decompose effects of affiliation into within and between-PO effects.
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In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchronous modalities. When integrated into longitudinal care relationships, telemedicine can increase access, reduce patient burden, and support continuity for people facing geographic, mobility, or socioeconomic barriers. However, telemedicine also introduces new clinical, regulatory, equity, and safety challenges that require deliberate policy design. Beyond its clinical considerations, telehealth offers environmental and logistical benefits, including reduced travel time and cost, decreased fuel consumption, lower transportation expenses, and lower greenhouse gas emissions. In this position paper, the American College of Physicians updates its previous policy paper on telemedicine to reflect changes in payment policy, licensure, prescribing authority, and utilization patterns that have occurred over the past decade and accelerated during the COVID-19 public health emergency. This paper focuses on access, payment policy, licensure, prescribing practices, equity, and patient safety across federal and state programs and private payers and emphasizes the conditions under which telemedicine should be integrated into clinical practice. Key developments addressed include the expansion and partial lapse of Medicare telemedicine waivers, evolving U.S. Drug Enforcement Administration rules governing prescribing, increased reliance on interstate practice, and normalization of telemedicine by private payers.
This Perspective examines a new Centers for Medicare & Medicaid Services (CMS) approach to outcome-aligned Medicare payments for technology-enabled long-term care.
Public health emergency waivers enacted during the COVID-19 pandemic dramatically expanded telemedicine use. Expiration of these waivers would limit access to this convenient care option for older adults, but it is unknown how expiration would affect patients' burden of care, quantified as health care contact days (days receiving in-person care). To measure the extent to which telemedicine days experienced by older adults enrolled in traditional Medicare may supplement in-person health care contact days and to estimate how telemedicine waiver expiration could increase the number of health care contact days. This is a cross-sectional study of the 2022 Medicare Current Beneficiary Survey examining a nationally representative sample of community-dwelling adults aged 65 years or older enrolled in traditional Medicare. Data analysis was performed from March 2025 to March 2026. The primary outcomes were total telemedicine days (days with any telemedicine service) and additional health care contact days if telemedicine waivers expired (telemedicine days converted to in-person contact days, assuming 100% substitution). Multivariable logistic and Poisson regressions evaluated associations between patient characteristics and the probability and rate of additional health care contact days. Among 5151 community-dwelling older adults (weighted number, 27 321 585 individuals; mean [SD] age, 74.6 [7.0] years; 2496 female individuals [52.4%]), 1294 (weighted 22.7%) used telemedicine. Telemedicine use varied widely (median [IQR], 1 [1-3] telemedicine day; maximum, 91 days), with 10.5% of telemedicine users (135 respondents) accounting for 50% of all telemedicine days. If telemedicine waivers expired and all affected telemedicine services were substituted with in-person services, 74.1% of older adults (951 respondents) using telemedicine would experience at least 1 additional health care contact day, totaling 8 772 118 additional contact days. Having more chronic conditions (adjusted odds ratio for >10 conditions, 8.42; 95% CI, 5.44-13.00) and difficulty getting places (adjusted odds ratio, 1.29; 95% CI, 1.10-1.53) were associated with higher odds of additional contact days. This cross-sectional study of older adults enrolled in traditional Medicare found that most older adults using telemedicine would experience additional health care contact days if telemedicine waivers expired and all affected telemedicine services were substituted with in-person services. The resulting burden would fall disproportionately on adults with multiple chronic conditions and difficulty getting places, potentially exacerbating access barriers for patients most in need of care.
Medication management in mobile care is highly coordination-intensive and frequently constrained by fragmented information flows and synchronous communication. This study evaluates the digital medication reordering process within the interoperable Linked Care platform, with regard to efficiency and user experience. A mixed-methods design combined time-logging data with qualitative interviews collected during a six-month real-world trial in mobile care. Digitally supported workflows were associated with shorter process durations, particularly in preparation and prescription authorization. Qualitative findings indicate reduced coordination effort, increased use of asynchronous communication, and perceived workload relief, contingent on system reliability and feedback mechanisms. Linked Care demonstrates potential to improve coordination-intensive medication processes in mobile care, provided that technical stability and interprofessional engagement are ensured.
Urine drug testing (UDT) is commonly used in substance use disorder (SUD) treatment. However, there is little evidence to guide optimal use of UDT and growing concern that some UDT may represent low-value care. To determine whether a statewide policy limiting Medicaid reimbursement for UDT is associated with testing frequency, expenditures, and clinical outcomes. This serial cross-sectional study was performed among Louisiana Medicaid beneficiaries between July 1, 2017, and February 29, 2020. Data were analyzed from November 1, 2024, to November 30, 2025. For each outcome, best-fit lines for pre-enactment trends were constructed and used to estimate postenactment trends, which were then compared with observed trends. The 3-way interaction of time by intervention period by outcome was analyzed to assess changes for each UDT utilization outcome compared with a matched control procedure (colonoscopy). Concomitant trends in overdose encounters and prescription of medications for opioid use disorder (MOUD) were also assessed. Statewide policy limiting Medicaid reimbursement for UDT enacted in July 2019. Colonoscopy rates were used as a temporal comparison procedure. Outcomes included rates of monthly UDT (total, presumptive, and definitive) and expenditures per 1000 beneficiaries for 24 months before and 7 months after policy enactment. The sample included a total of 900 678 unique Medicaid-eligible beneficiaries, 536 841 (59.6%) of whom were female and 606 012 (67.3%) were younger than 40 years. Following policy enactment, the monthly rate of change for total UDT utilization decreased from 0.67 (95% CI, 0.48- 0.85) to -1.03 (95% CI, -1.65 to -0.40) tests per month per 1000 beneficiaries (difference, -1.70 [95% CI, -2.34 to -1.06] tests per month per 1000 beneficiaries); presumptive UDT decreased from 0.42 (95% CI, 0.30-0.53) to -0.63 (95% CI, -0.92 to -0.35) tests per month per 1000 beneficiaries (difference, -1.05 [95% CI, -1.36 to -0.74] tests per month per 1000 beneficiaries); and definitive UDT decreased from 0.25 (95% CI, 0.17-0.34) to -0.39 (95% CI, -0.97 to 0.18) tests per month per 1000 beneficiaries (difference, -0.65 [95% CI, -1.23 to -0.07] tests per month per 1000 beneficiaries). These decreases were all statistically significant compared with colonoscopy (all P < .05). UDT expenditures also significantly decreased, totaling an estimated $14.8 million in savings during the 7-month postenactment period. The policy change was not associated with reduced MOUD receipt or increased overdose encounters. In this cross-sectional study, a state policy limiting reimbursement for UDT was associated with significant reductions in UDT utilization and expenditures. Future research and policymaking should investigate ways to optimize UDT for patient health while reducing low-value care.
Medicare Advantage plan payment depends on the health of enrolled patients. As a result, the extent to which beneficiary clinical severity is documented administratively-known as coding intensity-is greater in Medicare Advantage (MA) than in traditional Medicare, which inflates payment to plans. In 2024, the Centers for Medicare and Medicaid Services began phasing in a new risk adjustment model intended to reduce the susceptibility of MA payments to higher coding intensity. Using 2021 data, we compared average MA contract risk scores under the new model and the old model. Risk scores were 5.8% lower under the new risk adjustment model. Differences between average risks scores under the new and old model varied substantially across contracts and insurers. For example, 1 large insurer's risk scores were essentially unchanged across models while another large insurer's risk score was 18% lower under the new model. Contracts with higher estimated coding intensity had greater exposure to the new risk adjustment model. Our results suggest that the new risk adjustment model will likely reduce MA payments due to enhanced coding intensity, with these reductions appropriately targeting insurers that code more intensely.
Centers for Medicare & Medicaid Services (CMS)-designated Rural Health Clinics (RHCs) play a critical role in addressing diabetes in medically underserved areas. To address care gaps, 2 RHCs implemented an innovative collaborative pharmacist care model. This IRB-exempt retrospective study evaluated the impact of integrated pharmacist care on clinical outcomes for patients referred for diabetes management in 2 RHCs. Outcomes were analyzed for people receiving collaborative pharmacist-managed diabetes care between August 2021 and October 2023. Changes in pre-/postclinical outcomes and medication management were evaluated for patients who received pharmacist-provided care. The primary outcome was change in A1C from baseline to the end of the episode of care. Ninety-three patients received care over a median (IQR) of 247 (143, 405.5) days. Mean A1C significantly decreased from 9.3% to 7.7% (P < 0.001). Guideline-directed medication optimization improved significantly for patients with concomitant atherosclerotic cardiovascular disease, chronic kidney disease, and obesity. Heart failure medication optimization showed improvement but was not statistically significant. Significant increases were observed in continuous glucose monitor (CGM) and statin use. A collaborative pharmacist care model in RHCs significantly improved glycemic control and increased utilization of guideline-directed medication therapy for diabetes and cardiometabolic comorbidities. These findings add to the growing body of literature demonstrating positive clinical outcomes of pharmacist services in rural clinics and underscore the need for financial models that recognize the clinical value of pharmacist services in the RHC setting.
Current literature supports physical therapy (PT) as an initial treatment for patients with musculoskeletal pain without severe trauma, but state laws can limit timely access depending on the level of direct access permitted. We assessed whether more permissive direct access laws are associated with earlier PT use among Medicare patients with an atraumatic rotator cuff tear (ARCT). We obtained claims files from 2016 to 2018 for all US Medicare fee-for-service beneficiaries with an ARCT diagnosis in 2017, using 2016 data for baseline confounders and 2018 data to capture outcomes. Earlier PT was defined in 2 ways: PT first - seeing only a physical therapist on the first shoulder-related outpatient visit within 90 days of ARCT diagnosis and early PT - seeing a physical therapist within 30 days of this first visit. Multivariable logistic regressions assessed whether more permissive PT access laws were associated with greater odds of earlier PT use, adjusting for confounders. Compared with patients in limited access states, those in unrestricted and provisional access states had higher odds of PT first (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.5-2.1 and OR = 1.6, 95% CI: 1.3-2.0, respectively). Relative to patients in states with limited access, patients in states with provisional access had (OR = 1.2, 95% CI: 1.1-1.4) higher odds of early PT. No significant differences were observed between unrestricted and provisional access states. State laws permitting more direct access to PT may encourage earlier use of PT among patients with ARCT. Further research should investigate whether these law-associated treatment differences also improve health outcomes and lower costs.
Sex-related disparities affect diagnosis, referral, and prognosis of aortic valvular diseases. Contemporary US data on transcatheter aortic valve implantation (TAVI) by sex are limited. To characterize 10-year trends in TAVI use, periprocedural complications, and long-term outcomes among Medicare beneficiaries, stratified by sex. This nationwide, retrospective, population-based cohort study used US Medicare claims data from fee-for-service beneficiaries discharged after TAVI from January 1, 2013, to December 31, 2022. The median follow-up time was 2.19 (IQR, 0.94-3.79) years. Exclusions included patients who had concomitant valve surgery, infective endocarditis, valve-in-valve TAVI, transapical TAVI, TAVI for pure aortic insufficiency, or later conversion to Medicare Advantage. Analyses were conducted between October 1, 2024, and April 1, 2025. TAVI. The primary outcome was all-cause mortality. Secondary outcomes included periprocedural mortality, vascular complications, acute kidney injury, major or life-threatening bleeding, stroke, acute myocardial infarction (AMI), permanent pacemaker implantation (PPI), and hospitalization for heart failure (HF). Adjusted odds ratios (AORs) and hazard ratios (AHRs) with 95% CIs were estimated. The study included 314 123 patients (141 233 women [45.0%] and 172 890 men [55.0%]). Women were older than men (mean [SD] age, female: 80.3 [7.8] years; male: 79.4 [7.7] years; standardized mean difference, 12%). The proportion of female patients who underwent TAVI declined from 47.6% in 2013 to 43.6% in 2022 (P < .001). Compared with men, women had higher periprocedural mortality (2.5% vs 2.2%; AOR, 1.20 [95% CI, 1.14-1.26]), vascular complications (5.8% vs 3.6%; AOR, 1.65 [95% CI, 1.60-1.71]), and bleeding (10.4% vs 6.8%; AOR, 1.67 [95% CI, 1.62-1.71]) but less PPI (16.9% vs 20.0%; AOR, 0.81 [95% CI, 0.79-0.82]). Long-term mortality was lower in female patients (AHR, 0.92; 95% CI, 0.91-0.93), although their risks of HF hospitalization, AMI, stroke, and bleeding were higher. Among Medicare beneficiaries, women constituted a progressively declining proportion of patients treated with TAVI, experienced more periprocedural complications, and demonstrated modestly better long-term survival compared with men. Further work is needed to understand factors influencing these trends and to refine sex-specific strategies for optimal outcomes.