Socioeconomic deprivation: barriers to guideline implementation for cardiovascular disease

Abstract

The implementation of guideline-recommended care is associated with improved clinical outcomes for patients with cardiovascular disease. It is well documented that people living in low socioeconomic position have a high burden of cardiovascular disease and higher mortality rates. In this state-of-the-art review, the association of socioeconomic deprivation and guideline implementation is outlined, showing that across a range of settings, countries and clinical scenarios people with low socioeconomic position are further disadvantaged by sub-optimal provision of guideline recommended care. Reducing cardiovascular health inequality and improving population education should be priorities for governments. Greater attention to the provision of guideline-indicated care is recommended by tackling modifiable barriers to care. Broadly, the prioritization of use of advocacy, workforce, broader policy responses, data, randomized clinical trial re-design, quality indicators, and risk scores are recommended to reduce health inequalities for those who live in socioeconomic deprivation. A renewed focus on the provision of high-quality guideline-recommended cardiovascular care has the potential to reduce healthcare inequalities as well as improve clinical outcomes amongst our most socioeconomically deprived populations.

Keywords: Cardiovascular disease; Clinical practice guidelines; Implementation science; Inequality; Socioeconomic deprivation.