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Study reveals multiple inequalities in provision of aortic valve replacement

Widespread inequalities in the provision of aortic valve replacement (AVR) in England have been highlighted in a new study.

Published in the journal Open Heart, researchers assessed gender, ethnicity, and deprivation-based differences in the provision of AVR in England for adults with aortic stenosis.

Using English Hospital Episode Statistics between April 2016 and March 2019, they retrospectively identified 183,591 adults with aortic stenosis, of whom 31,436 subsequently underwent AVR.

Women had lower odds of receiving AVR compared with men (odds ratio (OR) 0.65; 95% CI 0.63 to 0.66), as did those of black (OR 0.70; 95% CI 0.60 to 0.82) or south Asian (OR 0.75; 95% CI 0.69 to 0.82) ethnicity compared to people of white ethnicity.

When examining AVR based on social deprivation, individuals residing in areas of high social deprivation were less likely to receive the procedure than those in the least deprived areas (OR 0.8; 95% CI 0.75 to 0.86).

Researchers also looked at whether the procedure was performed in a timely manner – meaning it was performed during an elective admission and without evidence of cardiac decompensation on or before AVR.

Timely replacement occurred in 65% of those of white ethnicities compared with 55% of both those of black and south Asian ethnicities. Furthermore, 77% of the those from the least deprived area had a timely procedure compared with only 58% of the most deprived regions.

Based on these findings, the researched suggested that ‘further research is 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’.