Geographical Inequality in Access to Aortic Valve Intervention in England: A Report from the UK Transcatheter Aortic Valve Implantation Registry and National Adult Cardiac Surgery Audit

Author:

Aktaa Suleman1ORCID,Ali Noman1ORCID,Ludman Peter F2ORCID,Curzen Nick3ORCID,Goodwin Andrew T4ORCID,Hildick-Smith David5ORCID,Kharbanda Rajesh K6ORCID,Jones Peter D7ORCID,Manuel Sue7ORCID,Phanthala Satya7ORCID,Blackman Daniel J1ORCID

Affiliation:

1. Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK

3. Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

4. Department of Cardiac Surgery, South Tees Hospitals NHS Trust, Middlesbrough, UK

5. Department of Cardiology, Royal Sussex County Hospital, Brighton, UK

6. National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

7. National Institute for Cardiovascular Outcomes Research, NHS Arden & GEM, Leicester, UK

Abstract

Background: For patients with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is a less invasive but equally effective treatment option compared with surgical aortic valve replacement (SAVR). In 2019, we reported low rates of TAVI in the UK compared with other countries in western Europe and highlighted profound geographical variation in TAVI care. Here, we provide contemporary data on access to aortic valve replacement by either TAVI or SAVR across clinical commissioning groups in England. Methods: We obtained aggregated data from the UK TAVI registry and the National Adult Cardiac Surgery Audit between 2019 and 2023. Rates of TAVI and SAVR procedures per million population were reported by clinical commissioning groups. The relationship between TAVI and SAVR rates was determined using Pearson correlation coefficients. Results: In 2022/23, the rates of TAVI and SAVR in England were 136 per million population and 60 per million population, respectively. The observed increase in TAVI rates since 2019/20 corresponded with a decline in SAVR rates. There remains substantial variation in access to both procedures, with an over tenfold variation in TAVI rates, and an over fourfold variation in SAVR rates across clinical commissioning groups in England. No relationship was identified between the rates of TAVI and those for SAVR (correlation coefficient 0.06). Conclusion: Geographical heterogeneity in access to TAVI persists over time, with the low rates of TAVI in many areas not compensated for by higher rates of SAVR, indicating an overall inequality in the treatment of severe aortic stenosis.

Publisher

Radcliffe Media Media Ltd

Reference22 articles.

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