Analysis of 20 years of data by NIHR Leicester BRC researchers finds women and patients in the most deprived areas are missing out
Women, people from ethnic minority backgrounds, and those from the most deprived communities are less likely to receive treatment after a diagnosis of the heart valve disease aortic stenosis, according to research presented at the British Cardiovascular Society conference in Manchester.
In one of the largest and most detailed study of its kind, researchers identified nearly 155,000 people diagnosed with aortic stenosis between 2000 and 2022 in a database of anonymised GP records from practices in England.
Analysis, led by a team from the University of Leicester (part of the Cardiovascular theme of the BRC), found that women were 11 per cent less likely than men to be referred to secondary care (such as a hospital specialist) after their diagnosis. Women were also 39 per cent less likely to have a procedure to replace their aortic valve.
Dr Anvesha Singh, Associate Professor at the University of Leicester and Consultant Cardiologist, 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.”
Aortic stenosis is the most common type of heart valve disease in the UK. It develops when the heart’s aortic valve becomes thickened, restricting blood flow out of the heart. Treatment involves replacing the valve through surgery or a keyhole procedure.
While some people won’t experience symptoms, prompt treatment is vital for people diagnosed with severe symptomatic aortic stenosis, as around 50 per cent will die within two years of symptoms beginning.
The analysis also showed that the patients living in the most deprived areas were 7 per cent less likely to be referred for secondary care after their diagnosis compared to patients in the least deprived areas, and 4 per cent less likely to undergo a procedure to replace their aortic valve.
South Asian and Black patients were also less likely to undergo a procedure to replace their aortic valve than White patients (27 per cent and 48 per cent, respectively). They were more likely to be referred to secondary care, though researchers say that this could reflect referrals for other heart issues not related to their aortic stenosis.
Dr Sonya Babu-Narayan, Clinical Director at the British Heart Foundation – which supported the research – and consultant cardiologist, said: “This study of over 150 thousand GP records has unveiled disparities in access to aortic valve treatment for women, South Asian and Black people, and people living in more deprived communities.
“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.”
For more information on the work of our Cardiovascular theme, visit their webpages.