{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T21:21:19Z","timestamp":1790976079577,"version":"4.1.0"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2012,8,28]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Socioeconomic deprivation is associated with increased heart failure (HF) incidence, hospitalization rates, and mortality. However, whether the delivery of survival-enhancing medical therapy is equitable remains uncertain. We examined secular trends in the uptake of key medical therapies (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, \u03b2-blockers, spironolactone) stratified by socioeconomic circumstances in patients with HF. Secondary analyses examined trends in HF incidence, prevalence, and survival.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>This study was a cross-sectional observational analysis of nationally representative primary care data from England. Treatments for patients with HF in 1999 and 2007 (n=13 330) were extracted from the General Practice Research Database. Socioeconomic circumstances were defined with the Index of Multiple Deprivation 2007, a weighted composite of 7 area-level deprivation domains. Treatment uptake estimates were age standardized. The incidence and prevalence of HF decreased year to year. Although clear socioeconomic gradients in both the incidence and prevalence of HF were apparent, the absolute difference between most and least deprived reduced over time. Uptake of therapies improved over time in both men and women. Angiotensin-converting enzyme inhibitor\/angiotensin receptor blocker uptake increased from 46% to 64%, \u03b2-blocker uptake from 12% to 41%, and spironolactone uptake from 3% to 20%. Modest age and sex inequalities were apparent. However, no consistent socioeconomic gradients were observed in either treatment or case fatality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Socioeconomic gradients in the incidence and prevalence of HF are reducing. Treatment is generally equitable and independent of socioeconomic circumstances. Most important, no significant inequality in outcomes was apparent. Future strategies should continue to address inequalities in the underlying causes of HF and to increase overall treatment levels further.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.111.088047","type":"journal-article","created":{"date-parts":[[2012,7,27]],"date-time":"2012-07-27T07:31:29Z","timestamp":1343374289000},"page":"1050-1057","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Community Care in England"],"prefix":"10.1161","volume":"126","author":[{"given":"Nathaniel M.","family":"Hawkins","sequence":"first","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Scholes","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavi","family":"Bajekal","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hande","family":"Love","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"O'Flaherty","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Raine","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Capewell","sequence":"additional","affiliation":[{"name":"From the Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Liverpool (N.M.H.); Department of Applied Health Research, University College London, London (S.S., M.B., R.R.); Legal and General Assurance Society Ltd, Surrey (H.L.); and Division of Public Health and Policy, University of Liverpool, Liverpool (M.O., S.C.), UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfr168"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.12.002"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.108.812172"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.110.959031"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.6.615"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp08X376195"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38043.414074.EE"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2005.11.009"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-7-40"},{"key":"e_1_3_4_11_2","unstructured":"Noble M McLennan D Wilkinson K Whitworth A Exley S Barnes H Dibben C . The English Indices of Deprivation. Crown Copyright. Department of Communities and Local Government. 2007. http:\/\/www.communities.gov.uk\/documents\/communities\/pdf\/733520.pdf. Accessed January 12 2011."},{"key":"e_1_3_4_12_2","first-page":"28","article-title":"Measuring deprivation in England and Wales using 2001 Carstairs scores","author":"Morgan O","year":"2006","unstructured":"Morgan O, Baker A . Measuring deprivation in England and Wales using 2001 Carstairs scores. Health Stat Q. 2006; 28\u2013 33.","journal-title":"Health Stat Q"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)04248-7"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.302.6779.766"},{"key":"e_1_3_4_15_2","first-page":"36","article-title":"The General Practice Research Database: quality of morbidity data","author":"Hollowell J","year":"1997","unstructured":"Hollowell J . The General Practice Research Database: quality of morbidity data. Popul Trends. 1997; 36\u2013 40.","journal-title":"Popul Trends"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp10X483562"},{"key":"e_1_3_4_17_2","first-page":"126","article-title":"Cancer registration: principles and methods: statistical methods for registries","author":"Boyle P","year":"1991","unstructured":"Boyle P, Parkin DM . Cancer registration: principles and methods: statistical methods for registries. IARC Scientific Publications. 1991; 126\u2013 158.","journal-title":"IARC Scientific Publications"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2003.12.012"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circheartfailure.109.879239"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfq027"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfq185"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.80"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.08.036"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr433"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.14.1651"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.55.7.475"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2008.01943.x"},{"key":"e_1_3_4_28_2","volume-title":"Policies and Strategies to Promote Social Equity and Health","author":"Dahlgren G","year":"1991","unstructured":"Dahlgren G, Whitehead M . Policies and Strategies to Promote Social Equity and Health. Stockholm, Sweden: Institute of Futures Studies. 1991. http:\/\/www.framtidsstudier.se\/wp-content\/uploads\/2011\/01\/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf. Accessed January 12, 2011."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2973"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmn105"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.108.772228"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.879478"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfn005"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfq228"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.270"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20760"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfp175"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfn006"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.01.037"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.07.026"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2008.01060.x"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.512"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_3_4_45_2","unstructured":"CACI Ltd. ACORN User Guide. http:\/\/www.caci.co.uk\/acorn-classification.aspx. 2009. Accessed January 12 2011."},{"key":"e_1_3_4_46_2","first-page":"717","article-title":"A framework for assessing the performance of health systems","volume":"78","author":"Murray CJ","year":"2000","unstructured":"Murray CJ, Frenk J . A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78:717\u2013731.","journal-title":"Bull World Health Organ"},{"key":"e_1_3_4_47_2","volume-title":"Concepts and Principles for Tackling Social Inequities in Health: Levelling Up, Part 1","author":"Whitehead M","year":"2007","unstructured":"Whitehead M, Dahlgren G . Concepts and Principles for Tackling Social Inequities in Health: Levelling Up, Part 1. Copenhagen, Denmark: World Health Organization Regional Office for Europe; 2007."},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.52.6.399"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.034017"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa055505"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052256"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi115"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl250"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14285-7"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.111.088047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:35:36Z","timestamp":1715582136000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.111.088047"}},"subtitle":["Reducing Socioeconomic Inequalities in Heart Failure"],"short-title":[],"issued":{"date-parts":[[2012,8,28]]},"references-count":53,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2012,8,28]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.111.088047"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.111.088047","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,8,28]]},"assertion":[{"value":"2011-12-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-06-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-07-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}