Inequalities in the NHS must be addressed after evidence showed rich people are more likely to receive treatment for heart disease than poor people, according to the public spending watchdog.

An estimated 182,000 people in Scotland have coronary heart disease (CHD), around 3.3% of the population.

In some more deprived areas around 25% of men over 75 have CHD but, according to Audit Scotland, people in deprived communities "are not always getting the same level of treatment as the rest of the population".

Treatments such as angioplasty, which widens the arteries, or heart bypass surgery are over 20% fewer than expected in deprived areas. The least deprived areas saw over 60% more than expected.

Audit Scotland said this "implies a lower level of access to these treatments for people in more deprived areas".

The report states: "The Scottish Government and NHS boards should monitor rates of the main cardiology procedures, compare these by board and by different groups, particularly in more deprived areas and with other countries…and use this evidence to identify priorities for spending to help improve outcomes and address inequalities, particularly in deprived areas".

The report found limited evidence of the effectiveness of the Government`s Better Heart Disease and Stroke Care Action Plan which set a national target for cardiovascular health checks.

It states: "It is not clear yet what the overall impact of these checks has been on the rates of heart disease, hospital admissions and deaths, although death rates have reduced in the 15% most deprived areas and the gap between the national average and the most deprived areas has narrowed slightly."

Funding pressures

Rates of heart disease in Scotland remain the highest in Western Europe, despite new cases falling by nearly a third in the last 10 years. Death rates have reduced by around 40%.

Audit Scotland found NHS cardiology spending has risen from £80m in 2002-03 to almost £146m last year, a rise of 50% when inflation is factored in.

The Royal College of Nursing has also highlighted pressure on funding for specialist heart nurses, with NHS Orkney no longer employing one and other boards including NHS Grampian and Borders facing uncertainty about future funding.

Director Theresa Fyffe said: "When it comes to specialist heart-failure nurses, the British Heart Foundation has found that they reduce hospital admissions by 35% and save the NHS £1826 per patient seen.

"Given the significant benefits that specialist heart-failure nurses bring, health boards which do not employ them or are thinking about cutting them should urgently reconsider this and make sure that every patient who needs their support has access to their expertise and experience.

"Cutting back on specialist heart-failure nurses is counterproductive not just for patients but for NHS finances as well. Indeed, it is symptomatic of the wider approach that health boards are taking to saving money, (such as) cutting posts to reduce their wage bills and therefore storing up potential problems for the future when there won't be enough nurses to deliver high-quality patient care."

Labour health spokeswoman Jackie Baillie said: "No one can read this report and not be shocked. This is a stark reminder of the big challenges facing our country. If people from poorer communities cannot get treatment that would save their lives, ministers should hang their heads in shame.

"This report must prompt big questions and serve as a wake-up call to the Scottish Government. In the face of all the rhetoric, the reality is that the NHS across Scotland is seeing services cut, staff lost and treatments delayed.

"The job of the Health Secretary is not just to tell us she is doing a wonderful job but to actually tackle some of the deep social injustice our country faces around health."