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Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris

Sekhri, N.; Timmis, A.; Chen, R.; Junghans, C.; Walsh, N.; Zaman, M.J.; Eldridge, S.; ... Feder, G.; + view all (2008) Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. BMJ , 336 (7652) pp. 1058-1061. 10.1136/bmj.39534.571042.BE. Green open access

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Abstract

Objectives: To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates. Design: Multicentre cohort with five year follow-up. Setting: Six ambulatory care clinics in England. Participants: 1375 consecutive patients in whom coronary angiography was individually rated as appropriate with the Rand consensus method. Main outcome measures: Receipt of angiography (420 procedures); coronary mortality and acute coronary syndrome events. Results: In a multivariable analysis, angiography was less likely to be performed in patients aged over 64 compared with those aged under 50 (hazard ratio 0.60, 95% confidence interval 0.38 to 0.96), women compared with men (0.42, 0.35 to 0.50), south Asians compared with white people (0.48, 0.34 to 0.67), and patients in the most deprived fifth compared with the other four fifths (0.66, 0.40 to 1.08). Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event. Conclusions: At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas. Not receiving appropriate angiography was associated with a higher risk of coronary events in all groups. Interventions based on clinical guidance that supports individualised management decisions might improve access and outcomes.

Type: Article
Title: Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmj.39534.571042.BE
Publisher version: http://dx.doi.org/10.1136/bmj.39534.571042.BE
Language: English
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/14482
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