A new study from King's College London has found that universal healthcare systems, such as the NHS, may provide better outcomes for non-White heart failure patients.
Published in the Journal of the American College of Cardiology (JACC), the study found that, after hospital admission, non-White patients were more likely to be seen by a heart failure specialist, receive guideline-recommended medications, and benefit from improved follow-up care compared with what has been reported in other healthcare systems.
Our findings suggest that when patients enter a universal healthcare system, many of the barriers that disproportionately affect ethnic minority groups - such as access to specialist care and consistent treatment - are reduced. In this setting, care is more standardised and guideline-driven, which may help explain why we observed more equitable outcomes in non-White patients. This highlights the potential for universal healthcare systems to mitigate disparities that are often reported in other healthcare models."
Dr Antonio Cannata, the first author and a Clinical Research Fellow at King's College London
Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs for oxygen. While it can be life-threatening and cause severe symptoms, it can often be managed with appropriate treatment and lifestyle changes.
Previous research has shown that people from ethnic minority backgrounds are at higher risk of developing cardiovascular disease, including heart failure, and often have poorer outcomes than White patients. However, much of this evidence comes from countries without universal healthcare systems.
The researchers analysed nationwide NHS data from 2018 to 2023, covering around 240,000 patients hospitalised with heart failure. They found ethnic minorities had better care and survival rates compared with what was reported in studies conducted in countries without universal healthcare systems.
After adjusting for age, sex, socioeconomic status and other factors, mortality risk was lower in all non-White groups compared with White patients: 19% lower in Black patients, 23% lower in Asian patients, and 28% lower in mixed or other groups. These differences persisted after discharge.
Specialist care emerged as a key factor in improving outcomes across all groups. It was associated with a 32% reduction in mortality in White patients and an 18 - 27% reduction in non-White groups. Non-White patients were more likely to receive in-hospital specialist care, which was linked to higher prescription rates of recommended treatments and may help explain the observed differences in outcomes. Indeed, for patients with heart failure, receiving appropriate in-hospital consultations with the heart failure team was associated in better quality of care, regardless of the degree of cardiac dysfunction.
These results were confirmed even considering the different socioeconomic backgrounds and the place of living. The importance of heart failure specialist care also emerged for patients residing in both deprived and affluent areas, highlighting the importance of appropriate care.
