Abstract P345: The Relationship between Social Deprivation and Disease Severity at Hospital Presentation for Cardiac Revascularisation: Is There a Link with Treatment Outcomes?
Background: Coronary heart disease (CHD) is the biggest cause of death and disability in the UK. In terms of provision of acute cardiac services, there is evidence to suggest that the cardiac care pathways may be fragmented. Some people get late referrals so that they enter the tertiary care pathway when the disease is too advanced. Others do not get elective referrals for tertiary care at all and only receive cardiac care under emergency admission. Consequently, their treatments become less effective and more costly. It is not clear why such health inequalities exist, although there is strong suspicion that they may be associated with factors linked to social deprivation.
Objectives: This study sought to explore whether social deprivation differences exist in (a) hospital presentation, (b) attributes and indicators of severity of disease, (c) treatments given, and (d) treatment outcomes (hospital stay time and complications, hospital and follow-up mortality).
Method: A quantitative observational cohort study was carried out by analysis of data from NHS databases for 14,830 patients that had undergone cardiac interventions at the Liverpool Heart & Chest Hospital NHS Foundation Trust from April 2007 and March 2011. The data was analysed by descriptive, univariate and multivariate statistics to explore the association between social deprivation and a composite of indicators of severity of coronary artery disease, complexity of the intervention, and indicators of delayed presentation, complications and mortality.
Results: The results indicated that the length of time before patients could access hospital tertiary care services and the number of admissions by emergency/urgent pathway for coronary revascularisation were significantly greater for patients from the most deprived quintiles. In addition, patients from the most deprived quintiles had significantly worse history of unhealthy lifestyle indices, greater disease severity indicators such as dyspnoea, poor left ventricular function, number of diseased vessels, comorbidity index and prolonged hospital stay, hospital and follow-up mortality.
Conclusions: There is evidence to suggest that patients from deprived areas have the worst history of unhealthy lifestyles. In addition, they present in hospital with more severe coronary arteries disease, poor left ventricular function and comorbidities likely related to delayed hospital presentation and admission by the emergency/urgent pathway. Deprived patients undergoing cardiac surgery also have longer hospital stay time and in-hospital death rates. In all groups, deprived patients had greater risk of follow-up death that may relate to disparities in secondary prevention measures.
- © 2013 by American Heart Association, Inc.