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. 1995 Apr;73(4):385–389. doi: 10.1136/hrt.73.4.385

Are the economically active more deserving?

B Gaffney 1, F Kee 1
PMCID: PMC483836  PMID: 7756076

Abstract

OBJECTIVE--To investigate the possibility of an association between the duration of medical treatment before coronary angiography and demographic and non-clinical factors. DESIGN--A systematic review of a random sample of 500 patients undergoing their first angiographic assessment. SUBJECTS--500 cases were selected randomly from patients investigated in 1991 at the two catheterisation centres in Northern Ireland. MAIN OUTCOME MEASURES--The duration of medical management before angiography. RESULTS--346 had elective and 154 urgent catheterisation. The duration of medical management was adjusted for both case mix (age at onset, body mass index, angina grade, history of myocardial infarction, history of hypertension, diabetes or hyperlipidaemia, treatment intensity) and other demographic variables (sex, smoking status, an indicator of "deprivation", and distance of the patient's area of residence from the hospital). After this adjustment the mean duration of medical management before angiography was twice as long for economically inactive patients as for those who were economically active. In a multiple regression, the relevant beta coefficient was 0.44 (95% confidence interval 0.33 to 0.58, P < 0.0001). CONCLUSIONS--These results suggest that, in making discretionary decisions about when to refer patients with angina for revascularisation assessment, doctors may be influenced by non-clinical factors unrelated to disease severity.

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Selected References

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  1. Ayanian J. Z., Epstein A. M. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991 Jul 25;325(4):221–225. doi: 10.1056/NEJM199107253250401. [DOI] [PubMed] [Google Scholar]
  2. Bernstein S. J., Hilborne L. H., Leape L. L., Fiske M. E., Park R. E., Kamberg C. J., Brook R. H. The appropriateness of use of coronary angiography in New York State. JAMA. 1993 Feb 10;269(6):766–769. [PubMed] [Google Scholar]
  3. Bickell N. A., Pieper K. S., Lee K. L., Mark D. B., Glower D. D., Pryor D. B., Califf R. M. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992 May 15;116(10):791–797. doi: 10.7326/0003-4819-116-10-791. [DOI] [PubMed] [Google Scholar]
  4. Blustein J. High-technology cardiac procedures. The impact of service availability on service use in New York State. JAMA. 1993 Jul 21;270(3):344–349. doi: 10.1001/jama.270.3.344. [DOI] [PubMed] [Google Scholar]
  5. Chamberlain D., Parker J., Balcon R., Webb-Peploe M., Cobbe S., Boyle D., Tynan M., Hunter S., Reval K. Eighth survey of staffing in cardiology in the United Kingdom 1992. Br Heart J. 1994 May;71(5):492–500. doi: 10.1136/hrt.71.5.492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chassin M. R., Kosecoff J., Solomon D. H., Brook R. H. How coronary angiography is used. Clinical determinants of appropriateness. JAMA. 1987 Nov 13;258(18):2543–2547. [PubMed] [Google Scholar]
  7. Cox J., Naylor C. D. The Canadian Cardiovascular Society grading scale for angina pectoris: is it time for refinements? Ann Intern Med. 1992 Oct 15;117(8):677–683. doi: 10.7326/0003-4819-117-8-677. [DOI] [PubMed] [Google Scholar]
  8. Curtis S. E. Use of survey data and small area statistics to assess the link between individual morbidity and neighbourhood deprivation. J Epidemiol Community Health. 1990 Mar;44(1):62–68. doi: 10.1136/jech.44.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Eisenberg J. M. Sociologic influences on decision-making by clinicians. Ann Intern Med. 1979 Jun;90(6):957–964. doi: 10.7326/0003-4819-90-6-957. [DOI] [PubMed] [Google Scholar]
  10. Elder A. T., Shaw T. R., Turnbull C. M., Starkey I. R. Elderly and younger patients selected to undergo coronary angiography. BMJ. 1991 Oct 19;303(6808):950–953. doi: 10.1136/bmj.303.6808.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Every N. R., Larson E. B., Litwin P. E., Maynard C., Fihn S. D., Eisenberg M. S., Hallstrom A. P., Martin J. S., Weaver W. D. The association between on-site cardiac catheterization facilities and the use of coronary angiography after acute myocardial infarction. Myocardial Infarction Triage and Intervention Project Investigators. N Engl J Med. 1993 Aug 19;329(8):546–551. doi: 10.1056/NEJM199308193290807. [DOI] [PubMed] [Google Scholar]
  12. Gray D., Hampton J. R., Bernstein S. J., Kosecoff J., Brook R. H. Audit of coronary angiography and bypass surgery. Lancet. 1990 Jun 2;335(8701):1317–1320. doi: 10.1016/0140-6736(90)91196-h. [DOI] [PubMed] [Google Scholar]
  13. Harris J. QALYfying the value of life. J Med Ethics. 1987 Sep;13(3):117–123. doi: 10.1136/jme.13.3.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hope T., Sprigings D., Crisp R. "Not clinically indicated": patients' interests or resource allocation? BMJ. 1993 Feb 6;306(6874):379–381. doi: 10.1136/bmj.306.6874.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kee F., Gaffney B., Canavan C., Little J., McConnell W., Telford A. M., Watson J. D. Is choice of general practitioner important for patients having coronary artery investigations? Qual Health Care. 1994 Mar;3(1):17–22. doi: 10.1136/qshc.3.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kee F., Gaffney B., Currie S., O'Reilly D. Access to coronary catheterisation: fair shares for all? BMJ. 1993 Nov 20;307(6915):1305–1307. doi: 10.1136/bmj.307.6915.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kee F. Referrals for coronary angiography in a high risk population. Qual Health Care. 1993 Jun;2(2):87–90. doi: 10.1136/qshc.2.2.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Krumholz H. M., Douglas P. S., Lauer M. S., Pasternak R. C. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias? Ann Intern Med. 1992 May 15;116(10):785–790. doi: 10.7326/0003-4819-116-10-785. [DOI] [PubMed] [Google Scholar]
  19. Lerner D. J., Kannel W. B. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J. 1986 Feb;111(2):383–390. doi: 10.1016/0002-8703(86)90155-9. [DOI] [PubMed] [Google Scholar]
  20. Lichtlen P. R., Nikutta P., Jost S., Deckers J., Wiese B., Rafflenbeul W. Anatomical progression of coronary artery disease in humans as seen by prospective, repeated, quantitated coronary angiography. Relation to clinical events and risk factors. The INTACT Study Group. Circulation. 1992 Sep;86(3):828–838. doi: 10.1161/01.cir.86.3.828. [DOI] [PubMed] [Google Scholar]
  21. Lyons C., Gumpert R. Medical audit data: counting is not enough. BMJ. 1990 Jun 16;300(6739):1563–1566. doi: 10.1136/bmj.300.6739.1563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Mays N., Chinn S. Relation between all cause standardised mortality ratios and two indices of deprivation at regional and district level in England. J Epidemiol Community Health. 1989 Jun;43(2):191–199. doi: 10.1136/jech.43.2.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Murabito J. M., Evans J. C., Larson M. G., Levy D. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation. Circulation. 1993 Dec;88(6):2548–2555. doi: 10.1161/01.cir.88.6.2548. [DOI] [PubMed] [Google Scholar]
  24. Murabito J. M., Evans J. C., Larson M. G., Levy D. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation. Circulation. 1993 Dec;88(6):2548–2555. doi: 10.1161/01.cir.88.6.2548. [DOI] [PubMed] [Google Scholar]
  25. Negus B. H., Willard J. E., Glamann D. B., Landau C., Snyder R. W., 2nd, Hillis L. D., Lange R. A. Coronary anatomy and prognosis of young, asymptomatic survivors of myocardial infarction. Am J Med. 1994 Apr;96(4):354–358. doi: 10.1016/0002-9343(94)90066-3. [DOI] [PubMed] [Google Scholar]
  26. Nord E. The significance of contextual factors in valuing health states. Health Policy. 1989;13(3):189–198. doi: 10.1016/0168-8510(89)90092-4. [DOI] [PubMed] [Google Scholar]
  27. Orencia A., Bailey K., Yawn B. P., Kottke T. E. Effect of gender on long-term outcome of angina pectoris and myocardial infarction/sudden unexpected death. JAMA. 1993 May 12;269(18):2392–2397. [PubMed] [Google Scholar]
  28. Park R. E., Fink A., Brook R. H., Chassin M. R., Kahn K. L., Merrick N. J., Kosecoff J., Solomon D. H. Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in practice. Am J Public Health. 1989 Apr;79(4):445–447. doi: 10.2105/ajph.79.4.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Patterson D. L., Treasure T. The culprit coronary artery lesion. Lancet. 1991 Nov 30;338(8779):1379–1380. doi: 10.1016/0140-6736(91)92248-z. [DOI] [PubMed] [Google Scholar]
  30. Petticrew M., McKee M., Jones J. Coronary artery surgery: are women discriminated against? BMJ. 1993 May 1;306(6886):1164–1166. doi: 10.1136/bmj.306.6886.1164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Romano P. S., Roos L. L., Luft H. S., Jollis J. G., Doliszny K. A comparison of administrative versus clinical data: coronary artery bypass surgery as an example. Ischemic Heart Disease Patient Outcomes Research Team. J Clin Epidemiol. 1994 Mar;47(3):249–260. doi: 10.1016/0895-4356(94)90006-x. [DOI] [PubMed] [Google Scholar]
  32. Shaukat N., de Bono D. P., Cruickshank J. K. Clinical features, risk factors, and referral delay in British patients of Indian and European origin with angina matched for age and extent of coronary atheroma. BMJ. 1993 Sep 18;307(6906):717–718. doi: 10.1136/bmj.307.6906.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Steingart R. M., Packer M., Hamm P., Coglianese M. E., Gersh B., Geltman E. M., Sollano J., Katz S., Moyé L., Basta L. L. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators. N Engl J Med. 1991 Jul 25;325(4):226–230. doi: 10.1056/NEJM199107253250402. [DOI] [PubMed] [Google Scholar]
  34. Williams R. B., Barefoot J. C., Califf R. M., Haney T. L., Saunders W. B., Pryor D. B., Hlatky M. A., Siegler I. C., Mark D. B. Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. JAMA. 1992 Jan 22;267(4):520–524. [PubMed] [Google Scholar]

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