Heart hologram

New report reveals major cardiology health inequalities across England

The Institute for Fiscal Studies have published a new report revealing “considerable” regional inequalities in the effectiveness of how doctors attended to heart attack patients across England between 2005 and 2018.

The research was funded by the Economic and Social Research Council and provides evidence of stark health disparities that mean large parts of England are experiencing a health deficit compared to those living in the capital.

The study found that cardiologists in London and the South East in general had the best survival rates for patients between 2005 and 2018. The data also showed however, that the North East had a total of around 330 heart attack deaths per year, whilst the East of England had approximately 550 per year, but that more than 80 of those were preventable if the average cardiologist efficacy in those regions was elevated to that seen in London.

The data was collated by using anonymised records of more than 500,000 NHS patients in England, in order to estimate the impact each consultant had on the likelihood each patient survived for at least a year after being admitted into a hospital.

Each consultant’s quality was measured by comparing the survival rates of their patients with survival rates achieved by all the other consultants in the same hospital.

Other key themes observed in the research were that:

  • Cardiologists in the North East and the East of England had the greatest detrimental impact on survival rates – among 100 essentially identical patients, four patients living in the North East and two more patients living in the East of England, would have survived for at least another year if they had access to the same level of care available in London.
  • On average, 14 out of every 100 patients died within a year of getting emergency treatment from a cardiologist in NHS hospitals, between 2005 and 2018.
  • A patient treated by a cardiologist ranked in the 90th percentile of effectiveness came out as 8.5 percentage points more likely to survive for a year after their heart attack, compared to an identical patient treated by a cardiologist ranked in the 10th percentile. This means that, in every 100 patients, a doctor in the 90th percentile would have an additional nine patients survive for at least a year, compared to one ranking in the 10th percentile.
  • For every 100 patients living in rural areas, one more patient would have survived if they were treated by a cardiologist with the same average skill as those operating in urban areas, meaning that those living in the countryside are in a health deficit compared to those situated in the more built-up, affluent urban areas.
  • Cardiologists who had more experience recorded better survival rates – treating 150 more patients over the past three years equated to one less death in every 100 patients.

George Stoye, an Associate Director at the IFS and the author of the new research said: “A key tenet of the NHS is to provide equal access to care for those with equal needs. However, this research shows that patients living in different parts of the country do not have access to the same quality of care.

“Cardiologists treating otherwise identical patients achieve very different survival outcomes, and cardiologists of equal skill are not evenly spread around the country. This means that patients living in certain areas – particularly in the North East and the East of England – receive, on average, worse care than patients living in other areas.

“However, even doctors working at the same hospital deliver very different outcomes. Patients have little choice over who treats them in an emergency situation, and the care quality they receive will vary according to the time and the place in which they seek care.

“Hiring and training doctors takes time, but the research shows that it is important that policymakers invest in carefully monitoring quality, to ensure that best practice is widely spread, and take other steps to ensure equal access to high quality care across the country.”

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