Health Inequities and Aortic Stenosis: Why Not Everyone Has Equal Access to Lifesaving Treatment

The deeper reality is that not everyone is treated equally for this potentially fatal illness. Racial and socioeconomic differences continue to influence who receives a diagnosis, sees a specialist, and receives potentially life-saving surgery or intervention, even in the face of revolutionary advancements in treatment.

Let us examine the definition of aortic stenosis, its treatment, and the reasons why care equality is as important as the underlying science.

Aortic Stenosis: What Is It?

Think of your heart as an extremely efficient pump. 

Through the aortic valve, a swinging door, the left ventricle, the heart's primary engine, pumps oxygen-rich blood into the aorta, which then distributes it throughout the body.

The aortic valve fails to open correctly when it narrows or stiffens, which is typically brought on by scarring, calcium accumulation, or congenital abnormalities. As a result, the heart has to work harder, which causes pressure, turbulence, and ultimately strain. Chest pain, exhaustion, edema, fainting, or sudden cardiac death may develop as a result.

Aortic Stenosis: What Causes It?

The most frequent cause, particularly among those over 65, is age-related deterioration.

Aortic bicuspid valve: a birth defect in which the valve has two flaps rather than three.

In regions of the world where access to antibiotics is restricted, rheumatic fever remains a contributing factor.

An echocardiography, a painless ultrasound of the heart that shows how effectively the valve is functioning, is usually used to identify it. This determines if the condition is mild, moderate, or severe.

The Significance of It When symptoms start to show

Aortic stenosis is a medical emergency once it becomes severe and symptomatic, but mild and moderate instances can frequently be tracked over time. The typical life expectancy following the onset of symptoms is only two to three years if treatment is not received.

Signs to look out for:

Breathlessness, particularly during exertion

swollen legs or ankles

Pain or tightness in the chest

Fainting or feeling dizzy

How Do You Treat Aortic Stenosis?

When it is time to replace a valve, there are two primary treatments:

1. Aortic valve replacement surgery (SAVR)

Surgery on the open heart

replaces the valve with a bioprosthetic valve (made from animal tissue, lower risk but shorter lifespan) or a mechanical valve (durable but requires lifelong blood thinners).

2. Aortic valve replacement with trans catheterization (TAVR)

Not too intrusive: A new valve is installed inside the old one by inserting a catheter, usually through the leg.

Perfect for people who are elderly or have medical issues that make open surgery dangerous.

Due to its success, TAVR—once only available to the very weak—is now being made available to a wider range of people.

A Hidden Crisis: Health Inequalities in the Treatment of Aortic Stenosis

Access to technology remains unequal despite its advancement. According to data, Black people who have aortic valve disease are:

A cardiologist referral is half as likely.

less likely to have open heart surgery or TAVR, despite the fact that both procedures are equally successful for all racial groups.

More likely to refuse the treatment, possibly as a result of a lack of trust or inadequate communication within the healthcare system

When geography and money are added, the gaps widen:

The likelihood of acquiring TAVR increases by 10% for every $10,000 increase in income.

If difficulties occur, patients who live more than 20 miles from a treatment facility are more likely to have unfavorable results.

How to Speak Up for Yourself or a Loved One

What is the best you can do? Speak up, be informed, and develop your curiosity.

Do not ignore symptoms if you are having them, particularly if you are older or have a family history of heart disease. See your primary care physician and, if necessary, request a referral to a cardiologist.

If you have aortic stenosis that is either moderate or severe:

Ask for a professional with knowledge of valve illness.

Find out if SAVR or TAVR is more appropriate for your preferences, age, and health.

Discuss the differences between mechanical and bioprosthetic valves.

Talk about the course of recovery and who will be in charge of follow-up treatment.

Additionally, if you belong to a community that has traditionally experienced healthcare restrictions, know that your inquiries are not only legitimate, but also crucial. Unless we demand it, equity in care does not occur.

The Big Picture: Improved Access Is Necessary for Better Science

Although it can be fatal, aortic stenosis is curable. There is science. There are the tools. Fair and timely access is still lacking in far too many situations.

Recognizing and working to eliminate structural disparities is necessary to close the gap in heart valve treatment. This entails providing care to underprivileged areas, training medical professionals and patients, and supporting laws that ensure everyone has access to life-saving care—not just those who are wealthy, close by, or privileged.