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Published on: August 9, 2024
An audit on access to coronary artery surgery within a health district using New Zealand priority criteria as a
W C Leung1, D Tregoning, M Farrer
1Department of Public Health Medicine, Sunderland Health Authority.
Insights
New Zealand
Area of Science:
- Cardiology
- Health Services Research
Background:
- Ischaemic heart disease management requires equitable access to revascularization procedures.
- Prioritization criteria for Coronary-Artery Bypass Graft (CABG) surgery are essential for fair resource allocation.
- Existing criteria may not fully account for disease severity and socio-demographic factors.
Purpose of the Study:
- To evaluate the applicability of New Zealand's priority criteria for Coronary-Artery Bypass Graft (CABG) access in a UK health district.
- To assess equity of access to CABG based on patient demographics and socio-economic status.
- To examine the correlation between priority scores and waiting times for cardiac interventions.
Main Methods:
- Retrospective review of 229 patient case notes from Sunderland, UK, who underwent coronary angiography.
- Application of New Zealand's established priority criteria, incorporating biological and social dimensions of ischaemic heart disease.
- Statistical analysis to compare access thresholds and correlate priority scores with waiting times for coronary angiography, CABG, and Percutaneous Transluminal Coronary Angioplasty (PTCA).
Main Results:
- The clinical threshold for CABG access in Sunderland was significantly higher than in New Zealand.
- After adjusting for disease severity, no inequity in access was found based on age, gender, smoking status, or deprivation.
- Weak correlations were observed between New Zealand Priority Criteria scores and waiting times for angiography, CABG, and PTCA (r = -0.22, -0.1, -0.54).
Conclusions:
- The New Zealand consensus criteria serve as a valuable benchmark for assessing and prioritizing access to cardiac surgery.
- The criteria facilitate a realistic evaluation of access, considering disease severity alongside patient characteristics.
- While correlations with waiting times were weak, the criteria offer a structured approach to managing ischaemic heart disease patient pathways.
Abstract:
A professional advisory group in New Zealand, consisting of cardiologists, cardiac surgeons and general practitioners have recommended priority criteria for access to Coronary-Artery Bypass Graft (CABG). They used published outcome studies in developing the criteria, and numerical scores were assigned to both biological and social dimensions of ischaemic heart disease. The New Zealand criteria were used to investigate access to services for patients in the UK in Sunderland, Tyne and Wear. Case notes of 229 Sunderland residents who underwent coronary angiography in the 1995 96 financial year were reviewed. The clinical threshold for access to CABG was much higher in Sunderland than in New Zealand. After controlling for the severity of disease, there was no evidence of inequity of access based on age, gender, smoking status or the deprivation indices of the patients' ward of residence. The correlation between the New Zealand Priority Criteria scores and the waiting time for coronary angiography, CABG and Percutaneous Transluminal Coronary Angioplasty (PTCA) was present, but weak (r = -0.22, -0.1 and -0.54 respectively). The New Zealand consensus criteria proved a useful benchmark both to assess access for patients with ischaemic heart disease to coronary artery surgery in a local Health District and to prioritise patients on the waiting list for coronary artery surgery. They allowed a realistic assessment of access according to age, gender, smoking status and deprivation by taking disease severity into account.
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