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

9th October 2023

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.’

World AIDS Day seeks to end inequality

1st December 2021

World AIDS Day is held every year on 1 December, and in 2021 the key theme is to both end inequality and the virus itself

A key theme of World AIDS Day 2021 is a call to end the division, disparity and disregard for human rights which has become associated with HIV infection. Acquired immunodeficiency syndrome (AIDS) was first recognised as a new disease in 1981 when a number of homosexual men succumbed to unusual opportunistic infections and rare malignancies.

It was later identified that these cases were due to infection with the human immunodeficiency virus type 1 (HIV-1) which is spread via sexual transmission through the lower genital and rectal mucosa, and it is these routes of infection that account for the vast majority of current and new infections. HIV targets the immune system, weakening an individual’s defence against many infections and as the virus both destroys and impairs the functionality of immune cells, those infected with the virus gradually become immunodeficient.

Although antiretroviral therapy (ART) has been available for many years and while the treatment is not curative, it does provide longer lives for patients and reduce HIV transmission. However, to date, there is still no effective vaccine but this might change as a trial is about to begin at Oxford University.

Despite the advances in treatment provided by ART, the HIV virus continues to represent a global major health challenge. According to the World Health Organization (WHO), the virus has already claimed 36.3 million [27.2–47.8 million] lives and WHO estimates that in 2020, there were 37.7 million [30.2–45.1 million] people living with HIV, of whom, over two thirds (25.4 million) reside in the African Region.

In order to access ART and associated counselling services for those with HIV, it is imperative to have equality of access to HIV testing, especially in areas of African, where the virus affects a huge number of people. Sadly however, a 2020 analysis from 16 countries in sub-Saharan Africa, revealed that while relative socioeconomic inequalities in uptake of HIV testing in the region have decreased to some extent, absolute inequalities have persisted or increased. 

Other data have been equally pessimistic. The Start Free, Stay Free, AIDS Free initiative which began in 2015 and has a five-year framework which called for a super Fast-Track approach to ensure that every child has an HIV-free beginning, that they stay HIV-free through adolescence and that every child and adolescent living with HIV has access to antiretroviral therapy.

The approach focused on 23 countries, 21 of which were in Africa, that accounted for 83% of the global number of pregnant women living with HIV, 80% of children living with HIV and 78% of young women aged 15–24 years newly infected with HIV. The group’s most recent report from 2020 provides additional evidence of the current inequalities of access among those with HIV, revealing how nearly half (46%) of the world’s 1.7 million children living with HIV were not on treatment in 2020 and 150,000 children were newly infected with HIV, which is four times more than the 2020 target of 40,000.

Despite having being discovered over 30 years ago, and with treatments that enable infected individuals to live a virtually normal life, HIV is still very much a global health concern. Given the current enormous and global effort directed towards fighting COVID-19, it is hoped that the 2021 World AIDS Day call can gather an equal amount of energy in both reducing the inequality of access to testing and treatment as well as ending HIV.