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Does ageism affect the management of ischaemic heart disease?
Matthew Bond1, Ann Bowling, Dorothy McKee
1Centre for Ageing Population Studies, University College London, UK.
Insights
Older cardiovascular disease patients receive fewer diagnostic tests, including exercise testing and angiography, compared to younger patients. This age-based disparity in diagnostic access appears to influence treatment decisions, suggesting age discrimination in cardiac care.
Area of Science:
- Cardiology
- Health Services Research
- Geriatrics
Background:
- Access to timely and appropriate cardiovascular interventions is crucial for patient outcomes.
- Age-related disparities in healthcare access and treatment have been reported across various medical fields.
- Understanding age-based differences in accessing diagnostic and therapeutic procedures for cardiovascular disease is essential for ensuring equitable care.
Purpose of the Study:
- To investigate age-based disparities in accessing diagnostic tests and interventions for cardiovascular disease.
- To analyze referral patterns for exercise testing, coronary angiography, and revascularization procedures based on patient age.
- To examine the receipt of thrombolysis where indicated for patients with diagnosed cardiovascular disease, stratified by age.
Main Methods:
- A retrospective case note analysis was conducted on 712 patients with diagnosed cardiovascular disease.
- The study included in-patients and a sample of new cardiac outpatients with ischaemic heart disease, angina pectoris, or acute myocardial infarction.
- Patient data were tracked for 12 months around their entry date into the study.
Main Results:
- Older patients with ischaemic heart disease were less likely to be referred for exercise tolerance tests and cardiac catheterisation/angiography compared to younger individuals.
- This age-based difference in diagnostic referrals was independent of gender and disease severity.
- While older patients were not discriminated against in receiving indicated treatments like revascularization or thrombolysis, selection bias at the investigation stage partially explained this.
Conclusions:
- Age appears to be a significant factor influencing differential treatment of older cardiac hospital patients.
- The findings suggest that older patients may face barriers in accessing essential diagnostic procedures, potentially impacting subsequent treatment.
- The results from this single hospital study align with broader research on equity of access by age to cardiological interventions, enhancing the generalizability of the findings.
Objectives:
To analyse access by age to exercise testing, coronary angiography, revascularisation (percutaneous transluminal coronary angioplasty/stent insertion and coronary artery bypass graft surgery) and receipt of thrombolysis, where indicated, for hospital patients with diagnosed cardiovascular disease.
Method:
Retrospective case note analysis, tracking each case backwards and forwards by 12 months from the patient's date of entry to the study. The setting was a district hospital in the eastern part of outer London. The case notes eligible for inclusion were those of elective and emergency in-patients with an in-patient ICD-10 code of ischaemic heart disease, angina pectoris or acute myocardial infarction and a consecutive 20% sample of new cardiac outpatients with these diagnoses.
Results:
Analysis of 712 case notes showed that older hospital patients with ischaemic heart disease, and with indications for further investigation, were less likely than younger people to be referred for exercise tolerance tests and cardiac catheterisation and angiography. This was independent of both gender and severity of condition. Older patients did not appear to be discriminated against in relation to receipt of indicated treatments (revascularisation or thrombolysis), although, in the case of revascularisation, older patients were more likely to have been filtered out at the investigation stage (catheterisation and angiography), so selection bias partly explains this finding.
Conclusions:
The current findings from a single hospital are comparable with the results from a broader study of equity of access by age to cardiological interventions in another district hospital in the same region. Although only two hospitals were analysed, the similarity of findings enhances the generalisability of the results presented here. It appears that age per se causes older cardiac hospital patients to be treated differently.