Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England (3 October 2023)

Summary

Aortic valve replacement (AVR) is a life-saving procedure for symptomatic severe aortic stenosis (AS), which relieves symptoms, increases life expectancy and improves quality of life. Little is known about the rate of AVR provision by gender, race or social deprivation level in the NHS across England. However, a large analysis examining AVR on the health service in England – the first of its kind – reveals striking inequalities in its provision.

Women, black and Asian people, and those living in the poorest parts of the country are much less likely to receive the life-saving procedure, the study shows.

“In this large, national dataset, female gender, black or south Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England,” the authors wrote.

Dr Clare Appleby, a consultant cardiologist at the Liverpool Heart and Chest hospital NHS foundation trust and an author of the study, said public health initiatives to understand and tackle these inequalities should be prioritised.

“Severe symptomatic aortic stenosis is a serious disease that causes mortality and reduces quality of life for patients,” she said. “Left untreated it has a worse prognosis than many common metastatic cancers, with average survival being 50% at two years, and around 20% at five years.”

Further research and public health initiatives to understand and address inequalities in the timely provision of AVR are important and should be prioritised in England.