Background and Aims: People of lower socio-economic status (SES) with coronary heart disease (CHD) are a highly vulnerable population because they have more risk factors for CHD, develop CHD younger, and are less likely to benefit from secondary prevention care and prevention programs. The aim of this qualitative study was to examine factors perceived by key health professionals to effect patients' of lower SES willingness and capacity to reduce cardiovascular risk and benefit from services.

Method: Qualitative research; 24 key health professional informants (11 physicians, 11 nurses, 2 other) who work with patients of low SES with CHD in Alberta, Canada were interviewed in a semi-structured format.

Results: The participants viewed SES as one of six key heath determinants for people with CHD. Of eight primary factors linked to SES (low income, ethnicity, aboriginal, education, mental illness, older age, single parent, high risk lifestyle), low income was seen to be the most important element. The low income disadvantage was magnified for the homeless, working poor, elderly, aboriginal, mentally ill, rural, and recent immigrants. Main barriers to successful secondary prevention in patients of low SES were perceived to be: the high cost of recommended medication, food, and activity; limited access to information, education and transportation; difficulty arranging and cost of taking time off work; co-morbidities and limited mobility; aboriginal - historical disadvantage, diabetes, and exposure to poverty and violence; homeless and mental illness - survival issues, lack of connection and support; immigrants - language and unfamiliarity magnifying access issues; multiple burdens; hopelessness; and stigma.

Conclusions: In patients of lower SES in Canada, a complex web of factors is perceived to curtail willingness and capacity to reduce cardiovascular risk and access to services.