Increased heart attack mortality in a medium sized city in Germany: key informant interviews with local medical health care workers

Abstract

Abstract Background Cardiovascular diseases are the leading cause of death worldwide. However, there are significant regional differences regarding mortality rates. A city located in Southwest Germany with approximately 125.000 inhabitants, has revealed a significantly increased heart attack mortality for the last two decades. In most of these years it recorded the highest rate in the federal state. Purpose The aim of this study was to assess influencing factors on the increased heart attack mortality in this city. Methods The study recruited health care workers in regular contact with heart attack patients in this city. Using a heterogenous sampling approach, the selection included different medical specializations (e.g. family doctor, intensive care nurse). We conducted qualitative interviews following a semi-structured guideline. Audio records of interviews were transcribed and processed using content analysis. Results We performed 17 interviews (female=6, immigration background=4). The central theme was an unhealthy cardiovascular lifestyle predominantly focusing on modifiable risk factors. Interviewees described the intensity of risk factors as much higher in the city than in the surrounding districts. Mostly they connected this to a high population share of people with low socioeconomic status or immigration background. Most interviewees did not see severe differences in health care provision and institutions in the city compared to other districts. Conclusion Socioeconomic factors were seen as the most powerful influence on the heart attack mortality. A healthier cardiovascular lifestyle of the population can only be achieved addressing social disparities within the city.