Best practice for prevention and treatment of cardiovascular disease through an equity lens: a review.
BACKGROUND
Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced.


OBJECTIVE
To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD.


METHODS
Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES).


RESULTS
Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions.


CONCLUSIONS
Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.
Beauchamp
Alison
A
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Alison.beauchamp@med.monash.edu.au
Peeters
Anna
A
Tonkin
Andrew
A
Turrell
Gavin
G
D019985:Benchmarking; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D011314:Preventive Health Services; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D012648:Self Care; D016540:Smoking Cessation; D012959:Socioeconomic Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents