if you're poor, have a heart attack, treated differently

Poor heart attack patients treated differently: study
February 13, 2007 CBC News

Poor people are less likely to be treated aggressively after a heart attack than wealthier people, suggests a new study by researchers at the University of Alberta.

The study, published in the January issue of the American Journal of Medicine, also suggests people from lower socioeconomic backgrounds who suffer a heart attack enter the emergency department more often but have higher mortality rates a year after an attack.

"We found a clear discrepancy when it comes to socioeconomic status," Dr. Padma Kaul said in a news release.

Kaul is in a group of University of Alberta researchers who tracked 5,622 patients in Alberta. The patients had entered a hospital emergency department with a first heart attack between 1998 and 2002.

"We may have equal access health-care coverage in Canada, but the bottom line is that people may not be getting equal treatment."

Rates of invasive procedures such as open-heart surgery or angioplasty were lower for the poor (36 per cent versus 48 per cent) and death was higher at one year (19.1 per cent versus 9.1 per cent).

But for those patients who did have cardiac procedures, the playing field is levelled, said Kaul.

Using neighbourhood median household income as an indicator of wealth, researchers classified patients into separate income groups. The poorest group of patients made less than $39,000 a year and the wealthiest group made more than $63,000.

They said patients belonging to the lowest socioeconomic status quartile were 72 per cent more likely to visit the emergency department than those in the highest quartile.

Researchers suggested those living in poor neighbourhoods often use the emergency department as their first stop for regular care, rather than a family doctor.

Many may not even have family doctors, said Kaul, who suggested that they are so focused on making ends meet, that they put off health problems until they're so severe that they require urgent care. She also noted that the poorer patients were older and had higher rates of diabetes, hypertension and elevated cholesterol levels.

"This obviously has implications for the health-care system," she said. "This study helps us identify the patient population that is most at risk and that we need to focus on."