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Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris
- Source :
- BMJ. 336:1058-1061
- Publication Year :
- 2008
- Publisher :
- BMJ, 2008.
-
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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Acute coronary syndrome
medicine.medical_treatment
Coronary Angiography
Chest pain
Health Services Accessibility
Angina Pectoris
Cohort Studies
Angina
Risk Factors
Internal medicine
medicine
Humans
Myocardial infarction
Aged
Cardiac catheterization
medicine.diagnostic_test
business.industry
Research
Hazard ratio
General Medicine
Middle Aged
Prognosis
medicine.disease
Surgery
England
Angiography
Female
medicine.symptom
business
Cohort study
Subjects
Details
- ISSN :
- 17561833 and 09598138
- Volume :
- 336
- Database :
- OpenAIRE
- Journal :
- BMJ
- Accession number :
- edsair.doi.dedup.....34112f6facf8c8eec3095e5bc5e06b62