Poor more likely to die after heart op

Friday, 3 April 2009 12:01 AM

By Laura Miller

Low income heart patients are more likely to die after surgery than those higher up the social scale, a report published by the British Medical Journal has found.

The ten year study, of nearly 45,000 patients from five hospitals in Birmingham and North West England, showed "social deprivation was a strong independent predictor of death".

Dr Mike Knapton, Associate Medical Director at the British Heart Foundation (BHF), said the study revealed "a major piece of unfinished business".

"Despite ten years of progress, people from deprived areas still disproportionately shoulder the burden of cardiovascular disease," he said.

He urged government to switch to a joined up approach that looks at prevention, access to services, rehabilitation and end of life care.

Heart disease is the commonest cause of early death in the western world and research has shown it is closely linked to social and economic deprivation.

Part of the reason for this is the impact of other lifestyle factors such as smoking, obesity and diabetes, associated with people on low-income. Each account for a significant reduction in survival following surgery.

Diabetes, for example, carried a 31 per cent increased risk of death, closely followed by smoking at a 29 per cent increase.

But even after adjusting for these factors, this latest study by Dr Pagano, a consultant and reader in cardiothoracic surgery, showed deprivation remained a strong cause of an increased mortality risk, which, the author argues, is a clear sign that in general life a lower income impacts badly on survival.

For heart patients, Dr Knapton said this means more needs to be done to give people access to, and encourage them to use, after-surgery care.

"This study highlights the fact that it is not enough to provide heart patients with high quality surgery, we also need excellent pre-operative care and cardiac rehabilitation to address inequalities in health," he said.

"Cardiac rehabilitation is a lifesaving and cost effective treatment, yet many patients still do not get access to it - a major piece of unfinished business."

"We need a joined up approach from government and health services. This is why the BHF, alongside 41 other organisations, has drafted recommendations for a new strategic approach to fight cardiovascular disease.

He urged policy makers to make heart health inequalities one of their top priorities.

In an editorial note accompanying Dr Pagano's study, two cardiac specialists from Edinburgh Royal Infirmary concluded that, "Decent education, adequate housing, and adequate employment opportunities are what are needed to narrow the gap between the health of the rich and the poor."

South-east England, one of the wealthiest parts of the country, has the lowest post-op death rate among heart patients.

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