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Urgent action required to ‘revive heart care’ and tackle stark inequalities

Women and older people are less likely to receive clinical guideline-recommended treatment than men and younger people if they experience myocardial infarction or are diagnosed with heart failure or atrial fibrillation, according to new research into heart care inequalities.

Led by a team from the University of Leeds and funded by the British Heart Foundation, the researchers analysed evidence from a range of studies from the last 20 years that explored how a person’s age, sex, ethnicity and geographical location are linked to the heart care they receive and their outcomes.

These studies were based on evidence from nationwide secondary care registries and primary care health records.

The resulting analysis, published in The Lancet Regional Health – Europe, showed that after an ST-segment elevation myocardial infarction (STEMI), women were around a third less likely than men to receive coronary angiography and percutaneous coronary intervention.

Following a non-STEMI, women were 28 per cent less likely than men to receive a coronary angiogram and less likely to be prescribed secondary prevention.

In addition, women and those aged 75 and over were found to be less likely to receive a diagnosis of heart failure in primary care, and less likely to be prescribed treatments to slow the progression of their heart failure.

Ethnic disparities were also apparent in heart care, although less extensive evidence prevented firm conclusions from being drawn.

Black patients with atrial fibrillation were less likely to receive blood thinning treatment to prevent stroke than white patients. However, south Asian patients did not appear to receive unequal treatment for myocardial infarction compared with white patients, and they had similar case fatality.

‘Firmly in the grip of a heart care crisis‘

The research also highlighted an estimated 500 potentially avoidable deaths in the UK each year among patients waiting for transcatheter aortic valve implantation. This is despite prompt treatment being crucial to survival as 50% of patients will die within two years of symptom onset.

The researchers hope that in better understanding differences in heart care it may enable the implementation of appropriate strategies to mitigate differences in outcomes. As such, the BHF is calling on the UK Government and all political parties to prioritise efforts to tackle cardiovascular disease and health inequalities in the run up to the next general election.

Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and consultant cardiologist, said: ‘These findings should sound the alarm bell for the state of heart care in the UK. This concerning review is further evidence that people’s experience of heart care was far from equal even before the Covid-19 pandemic began. The pandemic underlined and amplified existing health inequalities, and we fear these are worse than ever now that we are firmly in the grip of a heart care crisis.

‘To stop this crisis in its tracks and address the unjust inequalities in heart care, we need bold action from Government. Protecting our hearts by tackling risk factors will help to prevent heart disease and strokes happening in the first place.

‘Prioritising NHS heart care will allow people to get the help they need more quickly, preventing avoidable death and disability. And powering up research will unlock the treatments and cures of tomorrow to give more people hope for a bright and healthy future.’

Professor Chris Gale, professor of cardiovascular medicine at the University of Leeds and honorary consultant cardiologist at Leeds Teaching Hospitals NHS Trust, who led the research, added: ‘We need urgent action to revive heart care. The NHS is full of fantastic people who make truly monumental efforts every day to do the very best for their patients. Despite this, the NHS is creaking at the seams, and we see this played out in cardiovascular care and outcomes.

‘Past efforts to transform heart care and drive down waiting lists were hugely successful, and we must build on the lessons from these to move forward.

‘It’s also clear that we’re not making the most of NHS data, and we’re missing vital opportunities for this to inform policy and help target investment.

‘We need a systematic approach to collect data and report on all aspects of treatment, care and outcomes. Only then will we be able to improve patient’s experiences and outcomes across the board.’