Woman and older people less likely to receive gold-standard heart care, study suggests

Woman and older people are less likely to receive gold-standard NHS care for heart problems compared with men and younger people, a study suggests.

The British Heart Foundation (BHF) slammed the “unjust inequalities” in care as it said the nation is “firmly in the grip of a heart care crisis”.

It comes as a study examined heart care for patients across the UK.

Researchers, led by academics at the University of Leeds, examined registries tracking heart care among UK hospital patients in need of care for heart problems along with data from GP surgeries and other studies published over the last 20 years.

This included information on patients who had heart attacks, heart failure, atrial fibrillation (when the heart beats in an abnormal way) and aortic stenosis, which occurs when the aortic valve narrows and blood cannot flow normally.

The researchers found that women and older people “less frequently receive guideline-recommended treatment” than men and younger people.

Meanwhile, older people and women who had a heart attack were found to be less likely to receive invasive coronary angiography – a test which identified narrowing or blockages in the arteries – after a heart attack compared with men and younger people.

The researchers also found that older people and women wait longer for a diagnosis of heart failure.

And they are also less likely to receive medicine to slow the progression of their heart failure and atrial fibrillation, the researchers found.

There was also significant variation in care depending on where people live.

Waiting times for a procedure for aortic stenosis varied across different health bodies across England, they found.

In some regions, patients were waiting nine weeks for a transcatheter aortic valve implantation, while patients in others waited an average of 35 weeks.

The authors estimated that delays in treatment result in around 500 avoidable deaths in 2019 in the UK.

The BHF said that prompt treatment is “crucial” after a diagnosis of severe aortic stenosis because without it around half of patients will die within two years of symptoms beginning.

“Our review of the literature suggests that the UK NHS does not currently provide equitable care to all,” the authors wrote in the journal Lancet Regional Health – Europe.

“This is associated with differential outcomes amongst the population,” the authors wrote.

The authors also said it was difficult to draw conclusions about people from different ethnicities due to a lack of evidence.

But from the limited information available they believe that inequalities do exist, for instance, data suggests that black patients with atrial fibrillation are less likely to receive blood thinning treatment to prevent stroke than white patients.

The BHF, which funded the study, said that the research paints a “concerning picture of unequal care”.

Dr Sonya Babu-Narayan (pictured), associate medical director at the charity, 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.

“Prioritising NHS heart care will allow people to get the help they need more quickly, preventing avoidable death and disability.”

Lead author Chris Gale, professor of cardiovascular medicine at the University of Leeds and honorary consultant cardiologist at Leeds Teaching Hospitals NHS Trust, added: “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.”

A Welsh Government spokesperson said: “We published a women’s health quality statement in July last year to ensure services consider the specific needs of women and ensure timely, equitable access to diagnosis, treatment and rehabilitation services in all aspects of healthcare in Wales, including in heart disease.

“Wales already has a quality statement for heart conditions and we will continue to work with partners and health boards to improve the care of people with these conditions.”

A Government spokesperson said: “Preventing cardiovascular disease will be an important part of our upcoming Major Conditions Strategy, as will tackling the risk factors that lead to health disparities.

“The NHS England Long Term Plan includes key ambitions to improve care and outcomes for those individuals with cardiovascular disease.

“These include early detection through NHS Health Checks, free blood pressure checks and scans through our 119 community diagnostic centres – which have already delivered over five million tests, scans and checks, including for heart conditions.”

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