Referrals for coronary angiography in a high risk population.

Abstract

Objectives-To examine variations in referral for coronary angiography within Northern Ireland and relate these to local death rates from coronary artery disease (1CD rubrics 410-414). Design-A descriptive retrospective analysis of aggregate hospital activity data for 1979-88 and corresponding mortality rates in the local population. Setting-Two regional referral hospitals and 26 local district council areas. Patients-5173 patients aged 35-74 years with an underlying diagnosis of ischaemic heart disease, whose records contained complete information on their age, sex, and home address. Main measures-Age-standardised angiography rates and corresponding standardised death rates derived from the registrar general's reports. Results-Among the 26 constituent district council areas there was significant heterogeneity in the angiography rates, ranging from 62 to 335/100 000 in men and from 7 to 62/100 000 in women (likelihood ratio statistic 856 and 359 respectively). There was no significant association between these angiography rates and the local death rates from ischaemic heart disease. Conclusion-The results suggest a nonuniform threshold for referral for angiography.Implications-Clinicians need to examine the appropriate indications for referral for invasive investigation.

Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective

“…There are conflicting published reports on the effect of sex on use of these cardiac procedures. Under-referral of women for coronary angiography has been well documented [14][15][16] but interestingly does not appear to lead to lower subsequent use of revascularization procedures [14,16,17] . Supporting evidence comes from a register of 33 359 patients that showed no gender difference in use of revascularization following coronary angiography [2] .…”

Interpreting health outcomes

“…Wherever researchers have looked they have found large variations in the processes of care delivered to patients (Dawson 1987;Bunker 1990). These variations are seen internationally (McPherson et al 1982), geographically within countries (Kee 1993;Krakauer et al 1995), and between individual practitioners within the same locality (McPherson et al 1982). Large differences have been seen for surgical procedures (Jennett 1988), drug prescribing (Morton-Jones & Pringle 1993), general practitioner referrals (Wilkin & Dornan 1990;Roland & Coulter 1992) and the use of diagnostic tests (Royal College of Radiologists Working Party 1991).…”

Barriers to referral in patients with angina: qualitative study Commentary: Generalisability and validity in qualitative research

“…An inverse correlation exists between deprivation and rates of revascularisation in Liverpool, reflecting inequalities throughout the United Kingdom 1. Contributing factors cited include socioeconomic status,2 – 5 ethnicity and race,6 7 and sex 8 9…”