Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

OBJECTIVES: This qualitative study aims to analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD). DESIGN: A longitudinal qualitative study using in-depth semistructured interviews to explore patients’ experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives. SETTING: The University Hospital in Halle (Saale), Germany. PARTICIPANTS: 41 elderly patients (aged 59–80 years) who suffered from CHD. RESULTS: From various patient’s experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals. CONCLUSIONS: Differences in the patient’s knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient–physician communication and patient knowledge can change the patient’s understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment. TRIAL REGISTRATION NUMBER: DRKS00007839.