Conclusions

This Equity Audit of Heart Health in Wirral clearly demonstrates that although deaths from heart disease have fallen significantly over the past 10 years, the improvement has not been uniform across the peninsula. Death rates remain higher in the more deprived areas where access to services is generally lower. This suggests that the inverse care law still applies in Wirral and that vigorous efforts will be needed to redress the balance. Specific targets must now be agreed that help to focus attention on addressing the inequalities identified in this audit. Local decision makers will also need to consider how best to re-orientate resources across a range of agencies in order to bring about change. Finally, monitoring processes will be required that enable us to determine that inequalities have been reduced.

Further reading

1. Hart JT. The inverse care law. Lancet 1971;i: 405-412
2. Department of Health. National Service Framework for Coronary Heart Disease. London: Department of Health 2000
3. Department of Health. Saving Lives: Our Healthier Nation. London: The Stationery Office 1999
4. Acheson D, Independent Inquiry into Inequalities in Health Report. London: The Stationery Office 1998
5. Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart 1999;81:380-386
6. Department of Health. Health Survey for England: Cardiovascular Disease '98. London: The Stationery Office 1999
7. Gardner K, Chapple A. Barriers to referral in patients with angina: qualitative study. BMJ 1999;319:418-422
8. Tod AM, Read C, Lacey A, Abbott J. Barriers to uptake of services for coronary heart disease: qualitative study. BMJ 2001;323:214-218
9. Payne N, Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation with prevalence of angina and coronary mortality. BMJ 1997;314:257-261

Glossary

Acute Myocardial Infarction - heart attack
Angina pectoris - this literally means "pain in the chest" and occurs when there is insufficient blood supply to the heart muscle.
Coronary angiography - an investigation undertaken to obtain an x-ray image of the blood supply to the heart.
Coronary artery bypass grafting (CABG) - an open-heart operation in which blockages to the coronary arteries are by-passed by grafting on a length of artery or vein to bring a fresh blood supply to the heart muscle.
Coronary revascularisation - a procedure to improve the blood supply to the heart.
Equity - fairness. Equity implies that ideally, everyone should have a fair opportunity to attain their full health potential.
Inequity - unfairness
Morbidity - illness
Mortality - death
Percutaneous coronary transluminal angioplasty (PTCA) - a procedure involving the insertion of a small balloon on the end of a thin tube (catheter) into the coronary arteries where it is inflated to widen the blood vessels and improve the blood supply to the heart muscle.
Standardised Mortality Ratio (SMR) - this is a summary measure used to show how the local death rates compare with those in England & Wales and which takes account of age differences in populations.