Social inequalities in cardiovascular care: challenges and opportunities for action

Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide, with structural heart disease (SHD) presenting significant challenges in detection, diagnosis, and treatment. However, emerging evidence underscores the profound impact of social inequalities on cardiovascular care, exacerbating disparities among various demographic groups.

Understanding Social Inequalities

Social inequalities in cardiovascular care manifest across diverse demographic groups, including older people, individuals of lower socio-economic status, women, and ethnic minorities. These disparities arise from systemic barriers to access to healthcare, bias in treatment decisions, and disparities in healthcare outcomes.

To begin with, among older people, age-related biases and under-diagnosis contribute to delayed treatment and poorer outcomes. Additionally, individuals from less affluent backgrounds face barriers in accessing healthcare services, leading to under-diagnosis and advanced disease presentation. More specifically, they are more likely to experience delayed diagnosis or remain undiagnosed altogether. Additionally, they may encounter obstacles in navigating the treatment pathway and accessing specialized care. Reluctance to consult primary care doctors due to financial constraints or work obligations, particularly in rural areas where travel to healthcare facilities is burdensome, further compounds these challenges.

At the same time, women experience under-recognition of symptoms, delayed diagnosis, and inferior treatment outcomes compared to men. Women tend to delay consulting their doctors compared to men due as they may fail to recognise the symptoms in themselves, assume cardiovascular diseases (CVDs) are more common in men, and have caregiving responsibilities that impede seeking help.

Finally, also ethnic minorities encounter challenges in accessing healthcare due to language barriers, mistrust, and under-representation in clinical trials, resulting in delayed diagnosis and poorer outcomes.

Need for Multilevel Action

To address these social inequalities and enhance cardiovascular care across populations, concerted efforts at the global, national, and regional levels are imperative.

At an intergovernmental level, the World Health Organization (WHO) should advocate for the inclusion of SHD in national CVD strategies and raise awareness of inequalities driving disparities in detection and diagnosis. Likewise, the European Union (EU) should also develop a comprehensive Cardiovascular Health Plan, including targets for early detection of SHD to reduce disparities among vulnerable populations.

Governments should prioritize the detection and treatment of SHD, especially among older populations, by implementing annual check-ups and risk assessments. Healthcare providers, including non-clinical personnel like pharmacists, should leverage digital technologies, artificial intelligence (AI), and machine learning to enhance SHD diagnosis, particularly among marginalized groups, ensuring timely intervention and improved outcomes.

On the latter, the “Farnborough Community Pharmacy Digital Stethoscope Pilot”, led by GP and SHD Coalition member, Dr. John de Verteuil, sets a worth-noting example for the efficient tackling of these inequalities. In this pilot, a total of 86 patients were seen over six months, with 45% referred for echocardiography due to detected murmurs. Notably, the pilot identified critical cases, including one patient with severe aortic stenosis, showcasing the efficacy of the

pathway. All participants involved found the service favourable, prompting consideration for nationwide integration of community pharmacies into the detection process for heart valve disease.


Addressing social inequalities in cardiovascular care requires a collaborative and multi-dimensional approach involving policymakers, healthcare providers, and communities. By implementing targeted interventions and fostering inclusivity in healthcare delivery, disparities can be efficiently mitigated, advancing equitable access to high-quality cardiovascular care for all. Taking into consideration the complexities of cardiovascular health, while embracing diversity and addressing social determinants are pivotal steps toward achieving health equity and well-being for everyone.