Transcatheter aortic valve implantation (TAVI) can be a lifesaving intervention for individuals with aortic stenosis (AS), but access to timely treatment remains a challenge. Wil Woan chief executive officer of the charity Heart Valve Voice, which seeks to address under-diagnosis and under-treatment of heart valve disease, and Jonathan Byrne, consultant cardiologist at King’s College Hospital (London, UK), outline how this impacts AS care in the UK National Health Service (NHS), and outline steps for action.
New data from the latest Valve for Life transcatheter aortic valve implantation (TAVI) survey, compiled in January 2025, reveal a stark reality: up to 8.2% of patients on an elective TAVI pathway die before receiving treatment, with some centres reporting a mortality as high as 20%.
The findings expose a growing crisis in access to TAVI across the UK. Despite the dedication and expertise of clinicians delivering exceptional care under increasing pressure, system inefficiencies, health inequalities, and capacity constraints continue to put patients at risk.
Decisive action is urgently needed to prevent avoidable deaths and ensure timely access to this life-saving procedure.
Aortic stenosis (AS) is a progressive and fatal condition, and once symptoms are severe, patients have a 50% survival rate at two years without treatment. TAVI is a proven, minimally invasive intervention that can restore quality of life and significantly reduce hospitalisations. However, long waiting times for elective TAVI, with an average of 142 days from referral to procedure in the UK, are leaving thousands of patients at risk.
The data also reveal worrying inequalities in access to treatment. White patients are more likely to undergo TAVI, while ethnicity data remain unrecorded for over 30% of cases, making it difficult to fully assess the scale of disparities in access. Gender inequity is another pressing issue, with more than half of all TAVI patients being male. Women with AS are often underdiagnosed and undertreated, something that the charity Heart Valve Voice is actively working to address through awareness and advocacy.
Beyond the direct impact on mortality, delays in TAVI access are also placing a significant strain on the National Health Service (NHS). Patients who should be receiving planned interventions are instead presenting as emergencies, requiring crisis management, hospital admissions, and intensive care. This inefficiency increases costs, places pressure on an already overstretched workforce and further reduces capacity for scheduled procedures.
System reform: What needs to change?
Addressing this crisis requires urgent system-wide change to improve access to TAVI and reduce preventable deaths. There must be a national AS fast track pathway to ensure that no patient is left waiting for treatment beyond a clinically safe timeframe. Expansion of TAVI capacity across all NHS Trusts is critical, so that rising demand can be met effectively. Healthcare systems must be held accountable through data-driven performance measures, integrating AS waiting list mortality into ICB targets to drive transparency and service improvement. Referral pathways need to be improved so that every patient follows a clear, time-bound diagnostic and treatment pathway, ensuring that those most at risk are identified and treated as quickly as possible. Additionally, clinical teams must be given greater autonomy and the necessary resources to prioritise patients effectively and reduce waiting times.
The call to action
Healthcare professionals, policy makers, and charities alike need to recognise the urgent need for action to address AS waiting list mortality and ensure that no patient dies waiting for treatment. As part of this effort, it is critical that the Heart Valve Voice SLOW campaign, which raises awareness of the early symptoms of valve disease, is widely endorsed, ensuring that more patients are diagnosed earlier and referred for treatment in a timely manner.
The evidence is clear, and the solutions are within reach. If system inefficiencies, workforce challenges, and access barriers are addressed, preventable deaths can be avoided, and thousands of patients can receive the life-saving care they need. It is time to act.
