Cardiac StudyPoor patients are 44 per cent more likely to develop heart failure compared to better-off patients. New research also shows that although at greater risk, economically deprived patients are 23 per cent less likely to see a GP on an ongoing basis.
A UK study assessing the impact of socio-economic factors on the incidence, prevalence, treatment and follow-up of patients with heart failure is published in the current edition of the British Medical Journal. It highlights stark differences in the risk of a serious heart condition between the better off and less well off.
Irish studies of cardiovascular disease have also shown the same strong socioeconomic gradient, according to Prof Ian Graham, chair of the Department of Cardiology at Trinity College and Professor of Epidemiology and Preventative Medicine at the Royal College of Surgeons of Ireland.
"It is a cliche that the poor die young but the cliche is true in the case of cardiovascular disease," according to Prof Graham who is also a cardiologist at Tallaght Hospital in Dublin. "It is such a universal in western society it would be surprising of things were different here."
Irish studies had not looked specifically at heart failure or mortality, just at the level of cardiovascular disease, he said. "The question is what is doing it of course," he added.
Poorer patients faced a higher risk even when other factors such as smoking and weight were taken into consideration.
"The adverse impact of socio-economic deprivation on health and particularly cardiovascular health is well recognised," according to the authors of the BMJ report.
The study assessed patients participating in the Scottish continuous morbidity recording project, which involves a pool of 307,741 patients in 53 general practices. The research included 2,186 patients who developed heart failure during the period April 1999 through March 2000.
Until this study there was a shortage of research into social gradients in heart failure, the authors indicate. "This question is important as heart failure accounts for almost a quarter of all admissions to hospital for cardiovascular events, has a high mortality and places a great burden on all healthcare systems."
Direct costs in the UK at £905 million (€1,260m) account for 2 per cent of total National Health Service expenditure, the authors said.
Very strong differences became apparent when the research team from Scotland, Canada, England and Australia began assessing the figures.
"The age and sex standardised incidence of heart failure increased with greater socio-economic deprivation, from 1.8 per 1,000 population in the most affluent stratum to 2.6 per 1,000 population in the most deprived stratum." This represented a 44 per cent greater risk.
"On average patients were seen 2.4 times yearly, but follow-up rates were less frequent with increasing socio-economic deprivation, from 2.6 yearly in the most affluent subgroup to two-yearly in the most deprived subgroup," the authors said.
They found that once involved in treatments, there was no difference in the prescribing patterns between the better off and worse off. Despite this: "Estimated survival rates were significantly lower in the most deprived group," the researchers added.
Further study was needed to discover reasons for these differences, the authors concluded.