Papers

Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality

^a Sheffield Health, Sheffield S10 3TG

Correspondence to: Dr Payne

Objective: To explore the relation between rates of coronary artery revascularisation and prevalence of angina to assess whether use of health services reflects need.
Design: Prevalence of angina symptoms determined by postal questionnaire on 16 750 subjects (18 to 94 years). Comparison of data on use of coronary artery revascularisation with prevalence of symptoms and mortality from coronary heart disease.
Setting: Health authority with population of 530 000.
Subjects: Patients admitted to hospital for coronary heart disease; patients who died; and patients undergoing angiography, angioplasty, or coronary artery bypass graft. Cohort of 491 people with symptoms from survey.
Main outcome measures: Pearson's product moment correlation coefficients for relation between variables.
Results: Overall, 4.0% (95% confidence interval 3.7% to 4.4%) of subjects had symptoms. Prevalences varied widely between electoral wards and were positively associated with Townsend score (r =0.79; P<0.001), as was mortality, but the correlation between admission rates and Townsend score was less clear (r =0.47; P<0.01). Revascularisation rate and Townsend score were not associated. The ratio of revascularisation to number experiencing symptoms was inversely related to Townsend score (r =-0.67; P<0.001). The most deprived wards had only about half the number of revascularisations per head of population with angina than did the more affluent wards. In affluent wards 11% (13/116) of those with symptoms had coronary angiograms compared with only 4% (9/216) in poorer wards (²=4.96; P=0.026). Townsend score also inversely correlated with revascularisations per premature death from coronary heart disease (r =-0.55; P<0.01) and revascularisations per admission for myocardial infarction (r =-0.47; P<0.01).
Conclusion: The use of interventional cardiology services is not commensurate with need, thus exhibiting the inverse care law.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis

Julia Hippisley-Cox, Carol Coupland, and Richard Logan
BMJ 2005 331: 1310-1316. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• McComb, J. M., Plummer, C. J., Cunningham, M. W., Cunningham, D. (2009). Inequity of access to implantable cardioverter defibrillator therapy in England: possible causes of geographical variation in implantation rates. Europace 11: 1308-1312 [Abstract] [Full text]  
• Blackledge, H M, Squire, I B (2009). Improving long-term outcomes following coronary artery bypass graft or percutaneous coronary revascularisation: results from a large, population-based cohort with first intervention 1995-2004. Heart 95: 304-311 [Abstract] [Full text]  
• Strong, M., Maheswaran, R., Radford, J. (2006). Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework. J Public Health (Oxf) 28: 39-42 [Abstract] [Full text]  
• Hippisley-Cox, J., Coupland, C., Logan, R. (2005). Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 331: 1310-1316 [Abstract] [Full text]  
• Morris, R W, Whincup, P H, Papacosta, O, Walker, M, Thomson, A (2005). Inequalities in coronary revascularisation during the 1990s: evidence from the British regional heart study. Heart 91: 635-640 [Abstract] [Full text]  
• Parkes, J., Chase, D. L, Grace, A., Cunningham, D., Roderick, P. J (2005). Inequity of use of implantable cardioverter defibrillators in England: retrospective analysis. BMJ 330: 454-455 [Full text]  
• Yong, P F K, Milner, P C, Payne, J N, Lewis, P A, Jennison, C (2004). Inequalities in access to knee joint replacements for people in need. Ann Rheum Dis 63: 1483-1489 [Abstract] [Full text]  
• Britton, A., Shipley, M., Marmot, M., Hemingway, H. (2004). Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study. BMJ 329: 318- [Abstract] [Full text]  
• Ward, P R, Noyce, P R, St Leger, A S (2004). Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England. J. Epidemiol. Community Health 58: 89-96 [Abstract] [Full text]  
• Taylor, F C, Ascione, R, Rees, K, Narayan, P, Angelini, G D (2003). Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting. Heart 89: 1062-1066 [Abstract] [Full text]  
• Lacey, E A, Walters, S J (2003). Continuing inequality: gender and social class influences on self perceived health after a heart attack. J. Epidemiol. Community Health 57: 622-627 [Abstract] [Full text]  
• Stewart, S, Murphy, N, Walker, A, McGuire, A, McMurray, J J V (2003). The current cost of angina pectoris to the National Health Service in the UK. Heart 89: 848-853 [Abstract] [Full text]  
• Pell, J P, Denvir, M A (2002). Angioplasty, bypass surgery or medical treatment: how should we decide?. Heart 88: 451-452 [Abstract] [Full text]  
• Stewart, A, Rao, J, Osho-Williams, G, Fairfield, M, Ahmad, R (2002). Audit of primary care angina management in Sandwell, England. The Journal of the Royal Society for the Promotion of Health 122: 112-117 [Abstract]  
• Richards, H. M., Reid, M. E., Watt, G. C. M. (2002). Socioeconomic variations in responses to chest pain: qualitative study. BMJ 324: 1308-1308 [Abstract] [Full text]  
• Tod, A. M, Read, C., Lacey, A., Abbott, J. (2001). Barriers to uptake of services for coronary heart disease: qualitative study. BMJ 323: 214-214 [Abstract] [Full text]  
• Cornell, S J, Chilcott, J B, Brennan, A (2001). Is it feasible to plan secondary care services for coronary heart disease rationally? A quantified modelling approach for a UK Health Authority. J. Epidemiol. Community Health 55: 521-527 [Abstract] [Full text]  
• Lampe, F. C., Whincup, P. H., Shaper, A. G., Wannamethee, S. G., Walker, M., Ebrahim, S. (2001). Variability of Angina Symptoms and the Risk of Major Ischemic Heart Disease Events. Am J Epidemiol 153: 1173-1182 [Abstract] [Full text]  
• Green, D. G, Dixon, J., Appleby, J. (2001). Stakeholder health insurance: empowering the poorest patients Commentary: Stakeholder health insurance has disingenuous aims. BMJ 322: 786-789 [Full text]  
• Hemingway, H., Shipley, M., Macfarlane, P., Marmot, M. (2000). Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up. J. Epidemiol. Community Health 54: 510-516 [Abstract] [Full text]  
• Goyder, E. C, Botha, J. L, McNally, P. G (2000). Inequalities in access to diabetes care: evidence from a historical cohort study. Qual Saf Health Care 9: 85-89 [Abstract] [Full text]  
• Pell, J. P, Pell, A. C H, Norrie, J., Ford, I., Cobbe, S. M, Hart, J. T. (2000). Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study • Commentary: Three decades of the inverse care law. BMJ 320: 15-19 [Abstract] [Full text]  
• Rogers, A., Flowers, J., Pencheon, D. (1999). Improving access needs a whole systems approach. BMJ 319: 866-867 [Full text]  
• Pickin, D M, McCabe, C J, Ramsay, L E, Payne, N, Haq, I U, Yeo, W W, Jackson, P R (1999). Cost effectiveness of HMG-CoA reductase inhibitor (statin) treatment related to the risk of coronary heart disease and cost of drug treatment. Heart 82: 325-332 [Abstract] [Full text]  
• Gardner, K., Chapple, A., Green, J. (1999). Barriers to referral in patients with angina: qualitative study • Commentary: Generalisability and validity in qualitative research. BMJ 319: 418-421 [Abstract] [Full text]  
• MacLeod, M C M, Finlayson, A R, Pell, J P, Findlay, I N (1999). Geographic, demographic, and socioeconomic variations in the investigation and management of coronary heart disease in Scotland. Heart 81: 252-256 [Abstract] [Full text]  
• Skinner, J.S., Farrer, M., Albers, C.J., Neil, H.A.W., Adams, P.C. (1999). Patient-related outcomes five years after coronary artery bypass graft surgery. QJM 92: 87-96 [Abstract] [Full text]  
• Williams, R., Wright, J. (1998). Health needs assessment: Epidemiological issues in health needs assessment. BMJ 316: 1379-1382 [Full text]