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Abstract
Introduction Over the past decade, transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (AS) has grown rapidly. In the past year 7601 cases have been performed in the UK, an increase from 1290 cases pear year, 10 years ago.
A concern regarding the growth of any new treatment is ensuring equity of access to all. Data from the US has indicated that although AS frequency is reduced amongst black patients, when this cohort had symptomatic severe AS, they were less likely to receive aortic valve intervention than white patients.
Within the UK, differences in health outcomes have been observed between ethnic minority groups and the white group. There is also a higher incidence of cardiovascular mortality within the South Asian population.
Aim As a UK tertiary referral centre, located within an ethnically diverse area, we aimed to assess the breakdown of TAVI cases by ethnicity both nationally and locally.
Methods Local TAVI ethnicity data was taken from the NICOR database and included all cases performed within this centre. National level TAVI ethnicity data was taken from the BCIS audit for 2020-2022. Ethnicity categories have been selected in line with NICOR.
Information on both national and local ethnicity data was taken from the 2021 census of England and Wales. Local authorities were determined by postcode and ethnicity data for the local population was recorded. This was further refined to the local population aged ≥75; more reflective of the cohort undergoing TAVI.
Results At a national level, in 2021 the population of England and Wales was 59.6 million people. Of this, 81.7% were white, 4% Black, 8.6% Asian, 0.7% Chinese and 5% mixed/other. In the group aged ≥75, representing a group of 4.2 million people, 96.27% were white, 1.1% black, 2.06% Asian and 0.57% mixed/other. We note breakdown of Asian ethnicity to include Chinese data was not available. NICOR data showed TAVI was used in 96.5% white patients, 0.77% black, 2.03% Asian, 0.05 Chinese and 0.58% mixed/other.
The local population was found to include 3.13 million people from 20 local authority areas. 80.6% of these people were white, 6.28% black, 7.43% Asian, 0.96% Chinese and 4.73% mixed/other. The local population aged ≥75 equalled 233,410 people and was composed of 90.75% white people, 3.89% black, 4.19% Asian, 0.26% Chinese and 0.91% mixed/other. Of the local group that underwent TAVI 90.39% were white, 2.47% black, 5.52% Asian, 0.19% Chinese and 1.43% mixed/other.
Conclusion There was no significant difference in ethnicity between both national and local populations aged ≥75 and those undergoing TAVI. This is encouraging as it suggests that both nationally and locally, different ethnic groups are appropriately represented in those receiving this life-saving procedure. This study is however limited and further investigation into this complex issue is warranted.
TAVI by ethinicity(%)
Results table
Conflict of Interest I have no conflicts to declare