Deprivation shortens life expectancy of heart failure patients

Heart failure patients living in the most deprived postcodes are at risk of dying more than six months earlier than patients in the least deprived areas, according to a study by Leeds researchers.

The research, funded by the British Heart Foundation and published in the journal BMC Medicine, also found that the disparities in risk of death and life expectancy worsened over time. 

Despite patients visiting the same hospitals and taking part in the same studies, socioeconomic factors like income, employment, education and housing have an outsized effect on their life expectancy.

The study analysed data from 1,802 heart failure patients in West Yorkshire, led by the University of Leeds and Leeds Teaching Hospitals NHS Trust. After adjusting for factors like age, sex and other conditions, they found life expectancy for people in the most socioeconomically deprived areas was reduced by 2.3 years because of their condition, compared to 1.8 years for people in the least deprived areas. 

The study used data from people with heart failure recruited between 2006 and 2014, who were then observed for up to 10 years to assess survival. The average age was 69 years and 73 per cent of participants were male.

Dr Oliver Brown, Clinical Research Fellow in Cardiology at the University of Leeds, who led the study, said: “We have shown that despite patients visiting the same hospitals and taking part in the same studies, socioeconomic factors like income, employment, education and housing have an outsized effect on their life expectancy. The next step for us is to explore why these disparities exist.

“We hope this research can be valuable for both healthcare professionals and policymakers, and that steps can be taken to ensure the disadvantages experienced by those in more deprived areas are reduced.” 

While disparities were seen over every time period studied, they continued to worsen – the biggest difference in life expectancy between the most and least deprived areas was seen in the most recent group recruited between 2012 and 2014. 

Heart failure is a condition in which the heart cannot pump blood around the body as well as it should. It is often caused by a heart attack, high blood pressure or problems with the heart muscle. 

Heart failure can be debilitating – affecting a person’s ability to do day-to-day activities – and there are currently no effective treatments to stop the condition progressing. In the study, 72 per cent of people died within five years, although researchers highlight that treatments have improved since the study began in 2006. 

The researchers used postcodes and the Index of Multiple Deprivation (IMD) to determine people’s socioeconomic deprivation levels. Every postcode has an IMD score which estimates deprivation based on factors like income, employment, housing and education [2]. People in the study were grouped into three categories: those living in the most, middle and least deprived areas. 

The recent boost in health funding for deprived regions is a positive first step towards more people living in good health for longer.

Everyone in the study received their normal heart failure treatment, and researchers followed up with them for an average of five years to assess death rates for each category. They then compared these death rates to those they would expect to see, based on the national average for patients of the same ages and sex.

From this, they found that the risk of death for those in the least deprived areas was 11 per cent higher than expected, corresponding to a loss of life expectancy of 1.76 years. However, for patients in the most deprived areas, the risk of death was 24 per cent higher than expected, and 2.3 years of life expectancy were lost. 

The researchers now aim to investigate the factors driving this disparity. By understanding the reasons behind it, they hope to find ways of reducing the difference. 

Dr Sonya Babu-Narayan, Clinical Director at the British Heart Foundation, said: “There is substantial evidence that living in more deprived areas is associated with shorter life span, shorter health span and more cardiovascular disease. I find it troubling to again see statistics that show the cardiovascular survival gap between the rich and the poor is only getting worse. 

“That’s why it’s so important that Government prioritises policies that will help prevent cardiovascular disease and improve access to healthcare for everyone, including people living in more deprived areas. The recent boost in health funding for deprived regions is a positive first step towards more people living in good health for longer.” 

The British Heart Foundation’s report on cardiovascular health inequalities can be found here.