Women are less likely than men to receive treatment for aortic stenosis, a new study supported by the British Heart Foundation reveals.
The research showed that after a diagnosis of aortic stenosis, women were 11% less likely to be referred on to secondary care and 39% less likely to have a procedure to replace their aortic valve, when compared to men with the same diagnosis.
People from ethnic minority backgrounds and those living in the most deprived areas were also less likely to receive treatment to replace the damaged valve after diagnosis than other patients.
Researchers from the University of Leicester presented the findings at the 2025 British Cardiovascular Society Conference, highlighting the inequalities in diagnosis, referral and treatment for aortic stenosis across the UK.
Rates of referral and aortic valve interventions for aortic stenosis
Using anonymised GP records from NHS practices in England, the researchers identified 154,223 people aged 18 years and over with a first diagnosis of aortic stenosis between 2000 and 2022. They analysed rates of referral to secondary care and aortic valve interventions alongside data relating to sex, ethnicity and socioeconomic status.
Of the 154,223 patients newly diagnosed with aortic stenosis, half of the patients were women (50.4%), who were typically diagnosed at an older age than men. The majority of patients were White British (92.7%), with the remainder identifying as South Asian (2.7%), Black (1.4%), or of mixed or other ethnicities (1.1%). Patients from ethnic minority groups and those living in the most deprived areas were generally diagnosed at a younger age compared to other groups.
Primary care clinicians made approximately 80% of the diagnoses, and referred 28% of these cases to secondary care, with a median referral time from diagnosis of 17 months.
Women were 11% less likely to be referred to secondary care (HR 0.89; 95% CI 0.88 to 0.91) and 39% less likely to receive an aortic valve intervention than their male counterparts (HR 0.61; 95% CI 0.60 to 0.62).
People living in the most deprived areas were referred less frequently than those living in the least deprived areas (HR 0.93; 95% CI 0.90 to 0.96). When it came to receiving treatment, rates of aortic valve interventions were non-significant for the most deprived group (HR 0.97; 95% CI 0.94 to 1.01), but after additional adjustment for comorbidities, this became significant (HR 0.96 95% CI 0.92, 0.99).
Referral rates were higher among South Asian (HR 1.31; 95% CI 1.24 to 1.38) and Black patients (HR 1.21; 95% CI 1.12 to 1.31), compared to White patients. The researchers said this could reflect referrals for other heart issues not related to aortic stenosis, particularly as people from South Asian (HR 0.73; 95% CI 0.68 to 0.78) and Black (HR 0.52; 95% CI 0.46 to 0.58) backgrounds were less likely to receive treatment for aortic stenosis compared to White patients.
‘The clearest picture yet’
Dr Anvesha Singh, consultant cardiologist and associate professor at the University of Leicester’s Department of Cardiovascular Sciences, who was involved in the research, said: ‘Previous studies have shown lower rates of valve replacement in women, and clinicians had assumed that women were less likely to be diagnosed with aortic stenosis. This analysis using large, real-word data clearly shows that this is not the case, giving us the clearest picture yet of what is happening in day-to-day clinical practice.
‘Our study highlights potential inequities in management and care of this common and serious condition. More research is needed to understand the reasons for this and the true prevalence of aortic stenosis in different groups.’
Noting the disparities revealed in the study, Dr Sonya Babu-Narayan, consultant cardiologist at Royal Brompton and Harefield NHS Foundation Trust and clinical director at the British Heart Foundation, added: ‘We don’t yet have the full picture, but these findings are concerning, and we need more research to understand what is driving the differences seen. This will be crucial to enable action to address any underlying causes are stopping some people from having access to the heart valve treatment and care they need when they need it.’
Our Clinical Excellence in Cardiovascular Care returns on 2 July for a one-day event examining the latest advances in cardiology, including a session on the severe aortic stenosis eight-week fast track pathway from Kerry Pena, lead cardiac valve nurse specialist at Leeds Teaching Hospitals Trust. You can register for free now, and look out for the session on-demand via the Hospital Healthcare Europe website after the event.
At the previous Clinical Excellence in Cardiovascular Care event, a panel discussion on advances in interventional cardiology considered UK trials looking at intervening earlier in aortic stenosis for certain patients, asking the question as to whether even asymptomatic groups should be considered for treatment.
Research published in 2023 highlighted widespread inequalities in the provision of aortic valve replacement for adults with aortic stenosis in England when assessing gender, ethnicity and deprivation-based differences for adults.
