Social deprivation increases cardiac hospitalisations in chronic heart failure independent of disease severity and diuretic non-adherence

Objective-To examine whether social deprivation has any independent effect on emergency cardiac hospitalisations in patients with chronic heart failur e (CHF). Design-Cohort study of 478 patients with CHF who had been hospitalised befo re 1993 and who were followed up during 1993 and 1994. Setting-Emergency admissions within Tayside acute hospitals. Patients-478 CHF patients who had a previous myocardial infarction, a previ ous CHF admission, and were on diuretic treatment. Main outcome measures-Emergency hospital admissions are divided into those for all causes and those for cardiac causes only. Results-Social deprivation was significantly associated with an increase in the number of cardiac hospitalisations (p = 0.007). This effect was mainly caused by increasing the proportion of patients hospitalised in each depri vation category (26% in deprivation category 1-2 versus 40% in deprivation category 5-6, p = 0.03). This effect of deprivation was independent of dise ase severity, as judged by the dose of prescribed diuretic, the death race, and the duration of each hospital stay. Non-adherence with diuretic treatm ent could not account for these findings either. Conclusions-Social deprivation increases the chance Of a CHF patient being rehospitalised independently of disease severity. Possible explanations are that doctors who look after socially deprived patients have a lower thresh old for cardiac hospitalisation of their patients, or that social deprivati on alters the may a CHF patient accesses medical care during decompensation . Understanding how social deprivation influences both doctor and patient b ehaviour in the prehospital phase is now crucial in order to reduce the amp lifying effect that social deprivation appears to have on cardiac hospitali sations.