Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• International studies indicate disparities in evidence-based heart failure (HF) care access.
• Previous research highlights reduced access to ACE inhibitors (ACEIs) based on sex, age, and socioeconomic status.
• Gaps exist in studies accounting for multiple sociodemographic factors in HF treatment access.

Purpose of the Study:

• To investigate inequities in access to ACE inhibitors (ACEIs) among Swedish heart failure (HF) patients.
• To examine the influence of sex, age, socioeconomic status, and immigration status on ACEI access.

Main Methods:

• Analysis of individually linked register data for 93,258 Swedish adults hospitalized for HF (2005-2010).
• Multivariate regression models assessed the risk of no ACEI dispensation within 1 year of hospitalization.
• Adjustments were made for age, comorbidity, Angiotensin receptor blocker therapy, period, and follow-up time.

Main Results:

• Women had an adjusted odds ratio (OR) of 1.31 (95% CI 1.27-1.35) for no ACEI dispensation.
• The oldest patients showed an adjusted OR of 2.71 (95% CI 2.53-2.91) for no ACEI dispensation.
• Unemployed patients had an adjusted OR of 1.59 (95% CI 1.46-1.73) for no ACEI dispensation.

Conclusions:

• Access to ACE inhibitor (ACEI) treatment is significantly reduced for women, older patients, and unemployed individuals with heart failure (HF).
• These findings indicate inequitable access to ACEIs within the Swedish HF patient population.
• Future research should incorporate clinical data and mortality outcomes to further elucidate these disparities.