Female, black, Asian or poorer patients are less likely to receive aortic heart valve replacement surgery in England
A new study exposes considerable disparities in the availability of life-saving procedures via the NHS.
Experts say these significant differences in experience are ‘deeply concerning’.
The findings are published in the open-access journal Open Heart.
The authors write: ‘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.’
Aortic stenosis, characterised by the narrowing of the aortic valve due to calcium build-up, obstructs normal blood circulation and leads to symptoms such as shortness of breath, dizziness, and angina.
Researchers emphasise that aortic valve replacement (AVR) alleviates these symptoms and enhances life expectancy and overall quality of life.
Shockingly, up to one in four individuals with severe or very severe aortic stenosis may succumb within five years without AVR.
Nonetheless, there is limited knowledge about the inclusivity of AVR provision within England’s NHS.
To address this, researchers analysed data from Hospital Episode Statistics for England from April 2016 to the end of March 2019.
During this period, they identified 183,591 adults with aortic stenosis, of whom 31,436 underwent AVR. The study uncovered disparities: women with aortic stenosis were 30% less likely to receive AVR than men, and individuals of Black and South Asian backgrounds were 26% and 22% less likely, respectively, than their White counterparts.
Similarly, people in the most economically deprived areas were 24% less likely to undergo the procedure than those in more affluent areas.
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. 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.’
The team linked this data with general practice medical records in the nationally representative Clinical Practice Research Database (CPRD) to understand who received timely AVR.
Timely intervention was defined as AVR performed during scheduled admission without evidence of heart failure before or on the day of AVR.
Conversely, delayed intervention occurred during unscheduled/urgent admission or with evidence of heart failure before AVR.
Whilst there were no apparent gender-based differences, racial and socioeconomic disparities were evident.
Timely AVR was observed in approximately two-thirds (65%) of individuals of white ethnicity, compared to just over half (55%) of individuals of black and South Asian backgrounds.
Likewise, about two-thirds (68%) of those from the least deprived areas received timely AVR, compared to 58% of those from the most deprived areas. Delayed AVR was more prevalent among people of Black (32%) or South Asian (36%) ethnicity than among those of White ethnicity (28%).
Furthermore, one-third of individuals from the most deprived areas experienced delayed AVR, while approximately one in four (26%) from the least deprived areas did so.
It’s important to note that this study is observational and cannot establish causality. Additionally, it was not designed to identify the specific barriers to access or care provision.
The researchers emphasise the need for further investigation into the reasons behind the under-provision of AVR in specific population groups.
They suggest exploring whether these disparities are related to structural or systemic inequities, genetic differences, or variations in patient behaviour or preferences.
