OBJECTIVES: to extend the analysis by Rice et al - gender and deprivation-based differences in provision of aortic valve replacement (AVR) in England for adults with aortic stenosis (AS) – to a more recent time period.

METHODS: we retrospectively identified adults with a primary diagnosis of aortic stenosis who underwent aortic valve replacement on index from the English Hospital Episode Statistics (HES) between April 2019 and February 2024. The results were compared with the general population of England (Census, 2020) to assess any imbalances of gender and IMD identified.

RESULTS: 55,305 adults with primary diagnosis of AS were identified; of these, 26,910 underwent AVR. Only patients aged ≥ 65 were included in our analysis (N=22, 577). 59.62% were male, 38.93% female, in comparison with 45.79% and 54.21% respectively in the general population. Women were significantly less likely to receive AVR than men (OR 0.55; 95% CI 0.54-0.57; p-value < 0.001). Patients identified as the least deprived were more likely to receive AVR than people of the most deprived decile (OR 0.72; 95% CI 0.68-0.77; p-value < 0.001). For men from the most deprived IMD, the probability of receiving AVR was 0.67 compared to men from the least deprived IMD (95% CI 0.62-0.74; p-value < 0.001) while for women this probability was 0.80 (95% CI 0.72-0.89; p-value < 0.001).

CONCLUSIONS: differences in AVR treatment in England continue to exist based on gender and deprivation index. Women and people with greater deprivation had lower odds of receiving AVR treatment compared to men and people in the least deprived decile. The IMD (Index of Multiple Deprivation) appears to be a determinant of AVR more in men than in women. These results confirm the findings of Rice et al for the period 2016-2019.