Canadian Journal of Cardiology

Interventions Targeted to Address Social Determinants of Health in Ischemic Heart Disease: A Sex- and Gender-Oriented Scoping Review


      The burden of ischemic heart disease (IHD) is a major health problem worldwide. The detrimental effect of gendered (i.e., unevenly distributed between females and males) socioeconomic determinants of health (SDOH) on outcomes has been demonstrated, more so in female individuals. Therefore, addressing SDOH is a priority for the care implementation of patients with IHD. We conducted a scoping review to identify the types of SDOH-tailored interventions tested in randomized controlled trials (RCTs) among IHD patients, and whether the reporting of findings was sex-unbiased. We identified 8 SDOH domains: education, physical environment, healthcare system, economic stability, social support, sexual orientation, culture/language, and systemic racism. A total of 28 RCTs (2 ongoing) were evaluated. Since the 1990s, 26 RCTs have been conducted, mainly in Middle East/Asia and addressed only education, physical environment, healthcare system and social support. The 77% of studies focused on patient-education interventions, and around 80% SDOH-based interventions achieved positive effects on a variety of primary outcome(s). Among the limitations of the conducted RCTs, the most relevant were an overall low participation of females and racial/ethnical minorities, the lack of sex-stratified analyses and the missing opportunity of tailoring some SDOH interventions relevant for health. The SDOH-tailored interventions tested so far in RCTs, enrolling predominantly male patients and mainly targeting education and health literacy, were effective in improving outcomes among IHD. Future studies should focus on a wider range of SDOH with an adequate representation of females and minorities, that most would benefit from such interventions.

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