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Women, Black and Asian people, and those living in the most deprived areas of England are much less likely to receive life-saving aortic valve replacement surgery, according to new research published in Open Heart.
This type of open heart surgery significantly improves quality of life and increases life expectancy, and the researchers are now calling for public health initiatives to understand and tackle these inequalities.
Aortic valve replacement surgery vital for increasing life expectancy
Aortic valve replacement involves removing a faulty or damaged valve and replacing it with a new valve made from synthetic materials or animal tissue.
Patients may need aortic valve replacement if they have aortic stenosis (the narrowing of the aortic valve) or aortic regurgitation (a ‘leaky’ valve), which can cause symptoms such as chest pain, fatigue and shortness of breath.
Aortic valve replacement (AVR) not only relieves these symptoms, but increases life expectancy, and the researchers say that up to one in four of those with severe or very severe aortic stenosis will die within five years without the surgery.
However, until now, not much was known about how inclusive AVR provision is across the NHS in England. To fill this knowledge gap, the researchers analysed data from Hospital Episode Statistics for England spanning a three-year period.
No gender differences in timeliness of procedures
From April 2016 to March 2019, 183,591 adults with aortic stenosis were identified, 31,436 of whom underwent AVR.
The researchers found that women with aortic stenosis were 30% less likely to undergo AVR than men, people of Black ethnicity were 26% less likely than people of white ethnicity, while people of South Asian ethnicity were 22% less likely compared to people of white ethnicity.
People from the most deprived areas were also roughly a quarter (24%) less likely to undergo the procedure than those in the least deprived areas.
The researchers also compared the timeliness of the procedures. A timely procedure was regarded as that performed during a scheduled admission and without evidence of heart failure on or before AVR. A delayed intervention is it was unscheduled or urgent, or with evidence of heart failure on or before AVR.
People from Black and South Asian ethnicities were around 10% less likely to have a timely AVR (55% compared to 65% among people from White ethnicities).
There was a similar difference between the most and least deprived areas of England, with around 68% from the least deprived areas having a timely procedure compared to 58% in the most deprived.
There were no gender differences in terms of timeliness.
Further research needed to determine underlying causes for differences
The authors of the study say further research is now needed to “investigate the reasons for under provision of AVR in certain person groups and to identify whether disparity is related to structural or systemic inequities, genetic inequalities, or differences in patient behaviours or preferences.”
“Public health initiatives may be required to increase clinician and public awareness of unconscious biases towards minority and vulnerable populations to ensure timely AVR for everyone,” they added.