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IFS - Significant regional inequality in the effectiveness of cardiologists treating heart attack patients in England

New IFS research published today shows that there was considerable regional inequality in the effectiveness of doctors treating heart attack patients in different parts of England between 2005 and 2018. This suggests that people living in some parts of the country have access to lower quality NHS healthcare.

Heart attack deaths total around 330 a year in the North East of England and around 550 a year in the East of England. Over 80 of these patients could be saved in both regions if average cardiologist effectiveness in those regions was raised to the same level as that in London – one of the regions with the best performing cardiologists. These are the findings of the IFS working paper, published today and funded by the Economic and Social Research Council.

The research finds that, on average:

  • Cardiologists treating patients in London and the South East between 2005 and 2018achieved the best survival rates among heart attack patients, after taking into account the characteristics of their patients and the hospitals that they worked in.
  • Cardiologists in the North East and the East of England had the worst impact on survival rates during this period. Among 100 otherwise identical patients, an additional four patients living in the North East, and an additional two patients living in the East of England, would have survived for at least a year if they had instead been treated by a cardiologist with the average effectiveness of a cardiologist treating patients in London.
  • This means that if we could raise average cardiologist effectiveness in the North East and East of England to the level of London, over 80 additional people per year in each region would survive a heart attack each year. 

The research used anonymised records of over half a million NHS patients in England, over 13 years, to estimate the causal effect that each consultant cardiologist had on the probability that an individual heart attack patient survived for at least a year after being admitted to an NHS hospital under their care. The effectiveness of each consultant was calculated by comparing the survival rates of their patients with the survival rates of patients treated by all other consultants working in the same hospital, after adjusting for characteristics of their patient (such as age, sex and existing health conditions) that might affect survival chances.

The research also finds that:

  • On average, 14 out of every 100 patients died within a year of receiving emergency heart attack treatment by a cardiologist in an NHS hospital between 2005 and 2018.
  • There is considerable variation in the effectiveness of cardiologists in treating heart attack patients within the English NHS. A patient treated by a cardiologist ranked in the 90th percentile of effectiveness was 8.5 percentage points more likely to survive for a year after their heart attack than an identical patient treated by a cardiologist ranked at the 10th This means that for every 100 patients these doctors treat, the doctor in the 90th percentile would have an additional 9 patients survive for at least a year, all else being equal.
  • Patients living in rural areas typically received treatment from a less effective cardiologists than those living in affluent, urban areas. For every 100 patients living in rural areas, an additional patient would have survived if treated by a cardiologist with the same average effectiveness as one who treated patients in the most affluent urban areas.
  • Cardiologists with more experience in treating heart attack patients achieved higher survival rates. Treating an additional 150 heart attack patients over the three previous years was associated with one fewer death for every 100 patients treated in a given year.

George Stoye, an Associate Director at the IFS and the author of the new research said:

“A key tenet of the NHS is to provide equal access to care for those with equal needs. However, this research shows that patients living in different parts of the country do not have access to the same quality of care. Cardiologists treating otherwise identical patients achieve very different survival outcomes, and cardiologists of equal skill are not evenly spread around the country. This means that patients living in certain areas – particularly in the North East and the East of England – receive, on average, worse care than patients living in other areas. However, even doctors working at the same hospital deliver very different outcomes.

Patients have little choice over who treats them in an emergency situation, and the care quality they receive will vary according to the time and the place in which they seek care. Hiring and training doctors takes time, but the research shows that it is important that policymakers invest in carefully monitoring quality, to ensure that best practice is widely spread, and take other steps to ensure equal access to high quality care across the country.”

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