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a Centre for Ageing
Population Studies, Department of Primary Care and Population Sciences,
Royal Free and University College Medical School, Royal Free Campus,
Rowland Hill Street, London NW3 2PF, UK, b Department of Cardiology, John Radcliffe
Hospital, Oxford, UK, c Department of Health Care for the Elderly,
Pinderfields Hospital, Wakefield, UK, d Department
of Health Care for the Elderly, Edinburgh Royal Infirmary, Edinburgh,
UK, e Department of Health Care for
the Elderly, Princess Royal Hospital, Haywards Heath, Sussex, UK
Correspondence to: Professor Bowling rfpc0034{at}rfhsm.ac.uk
Accepted 13 February
2001
OBJECTIVES
To assess whether patients
with heart disease in a single UK hospital have equitable access to
exercise testing, coronary angiography, and coronary artery bypass
graft surgery (CABG).
METHODRetrospective analysis of
patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study.
SETTINGSingle UK district hospital
in the Thames Region.
PATIENTSPatients (elective and emergency) with a cardiac
ICD inpatient code at discharge or death, or who were referred to
cardiology or care of the elderly unit over a 12 month period in
1996-7 (new episodes) were included.
RESULTSAnalysis of 1790 hospital
case notes revealed that, despite having indications for intervention
identical to those of younger patients, older patients (that is, those
aged > 75 years) and women, independently, were significantly less
likely to undergo exercise tolerance testing (exercise ECG) and cardiac
catheterisation. The similar trends for age and access to CABG did not
achieve significance. While clinical priority scores also independently predicted access to cardiac catheterisation and CABG, considerable numbers of patients in high clinical priority groups were not referred
for either procedure.
CONCLUSIONSThe management and
treatment of older patients and women with cardiac disease may be
different from that of younger patients and men. Given the similarity
of the indications for treatment and the lack of significant
contraindications or comorbidities as a cause for these differences,
one possible explanation is that these patients are being discriminated
against principally because of their age and sex. Although clinical
priority scores independently predicted access to catheterisation and
CABG, large proportions of patients in high priority groups were not
referred. This implies that the New Zealand priority scoring system may be more equitable than UK practice. The cost implications of redressing these inequities in service provision would be considerable.
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