Community Care in England: Reducing Socioeconomic Inequalities in Heart Failure
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 inhibitor (ACEI) or angiotensin receptor blocker (ARB), beta-blocker, spironolactone) stratified by socioeconomic circumstances in patients with HF. Secondary analyses examined trends in HF incidence, prevalence and survival.
Methods and Results—Cross-sectional observational analysis of nationally representative primary care data from England. Treatments for patients with HF in 1999 and 2007 (n=13,330) were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using the Index of Multiple Deprivation 2007, a weighted composite of seven area level deprivation domains. Treatment uptake estimates were age-standardized. The incidence and prevalence of HF decreased year-on-year. Although clear socioeconomic gradients in both 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. ACEI/ARB uptake increased from 46% to 64%, beta-blockers from 12% to 41%, and spironolactone from 3% to 20%. Modest age and gender 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 importantly, no significant inequality in outcomes was apparent. Future strategies should continue to address inequalities in the underlying causes of heart failure and further increase overall treatment levels.
- Received December 22, 2011.
- Accepted June 13, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited