Community Care in England

Abstract

Background-Socioeconomic deprivation is associated with increased heart failure (HF) incidence, hospitalization rates, and mortality. However, whether the delivery of survival-enhancing medical therapy is equitable remains uncertain. We examined secular trends in the uptake of key medical therapies (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, ␤-blockers, spironolactone) stratified by socioeconomic circumstances in patients with HF. Secondary analyses examined trends in HF incidence, prevalence, and survival. Methods and Results-This study was a cross-sectional observational analysis of nationally representative primary care data from England. Treatments for patients with HF in 1999 and 2007 (nϭ13 330) were extracted from the General Practice Research Database. Socioeconomic circumstances were defined with the Index of Multiple Deprivation 2007, a weighted composite of 7 area-level deprivation domains. Treatment uptake estimates were age standardized. The incidence and prevalence of HF decreased year to year. Although clear socioeconomic gradients in both the incidence and prevalence of HF were apparent, the absolute difference between most and least deprived reduced over time. Uptake of therapies improved over time in both men and women. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker uptake increased from 46% to 64%, ␤-blocker uptake from 12% to 41%, and spironolactone uptake from 3% to 20%. Modest age and sex inequalities were apparent. However, no consistent socioeconomic gradients were observed in either treatment or case fatality. Conclusions-Socioeconomic gradients in the incidence and prevalence of HF are reducing. Treatment is generally equitable and independent of socioeconomic circumstances. Most important, no significant inequality in outcomes was apparent. Future strategies should continue to address inequalities in the underlying causes of HF and to increase overall treatment levels further.

Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity

“…For example, increased uptake of specific medical technologies to prevent heart failure was found to reduce absolute differences in heart failure rates by socioeconomic status among patients in the English General Practice Research Database (GPRD) from 1999 to 2007. 31 …”

Socioeconomic Deprivation and Survival After Heart Transplantation in England

“…11 There are socioeconomic gradients in the incidence, prevalence, and case-fatality rates of heart failure in England, but the magnitude of these gradients has reduced in the past decade. 12 Importantly, the use of evidence-based treatments for heart failure seem to be independent of SED within the NHS in England. The association between SED and outcomes after heart transplantation has not been examined in a country with a universal healthcare system.…”

Received and needed social support in relation to sociodemographic and socio‐economic factors in a population of people on sick leave due to heart failure

“…On basis of the present study, it can be determined that inequalities exist between different socio‐economic groups regarding social support for heart failure patients during sick leave. It has previously been described that socio‐economic deprivation implies health inequalities for people with heart failure 19, 21. In addition, a review from 2013 states that people with lower socio‐economic status commonly have lower social capital than people with higher socio‐economic status,22 and low social capital was described as associated with inequalities in health 22.…”