Socioeconomic Differences in Patient Pathways of Secondary Prevention after Ischaemic Heart Disease: A Nationwide Cohort Study

AIMS: Socioeconomic differences in secondary prevention following ischaemic heart disease (IHD) remain insufficiently understood, particularly during the transition from hospital to primary care. This study examined disparities in cardiac rehabilitation (CR), preventive medication, and general practice (GP) follow-up in a nationwide cohort. METHODS: This nationwide population-based retrospective cohort study included 93,159 individuals hospitalised with IHD between 2016 and 2022. Measures included CR uptake and adherence, redeemed antiplatelet and statin prescriptions, annual GP follow-up, and a count of three components as an indicator of comprehensive secondary prevention. Relative risks (RR) were estimated using modified Poisson regression, adjusted for demographic and clinical factors. RESULTS: Within six months, 41.2% initiated CR, of whom 73.7% adhered. During follow-up, 86.1% and 77.0% redeemed antiplatelet and statin prescriptions, respectively, while 56.0% attended annual GP follow-up. Only 25.9% achieved all three components. The likelihood of receiving all three components was lower among individuals with short education (RR 0.91; 95% CI 0.88-0.94), those living alone (RR 0.77; 95% CI 0.75-0.79), individuals with low income (RR 0.70; 95% CI 0.67-0.73), or unemployment (RR 0.82; 95% CI 0.75-0.89). Socioeconomic differences were most pronounced for CR uptake. Notably, 7.6% of individuals received none of the recommended components, indicating a subgroup with low engagement in secondary prevention. CONCLUSION: Substantial socioeconomic differences persist in secondary prevention after IHD, reflecting inequalities in access to and engagement with care, despite a universal healthcare system. Addressing these gaps requires equity-oriented, cross-sectoral strategies at critical transition points in care.