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Need for invasive cardiological assessment and intervention: a ten year review
C A MacRae1, M S Marber, C Keywood
1St Peter's Hospital, Chertsey, Surrey.
Insights
This audit of invasive cardiology procedures in North West Surrey from 1979-88 shows continuous growth. National requirements for procedures like coronary angiography and bypass surgery were estimated, highlighting potential service gaps.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- The North West Surrey Health District's utilization of invasive cardiology and cardiopulmonary bypass procedures was examined.
- Audits were conducted over a ten-year period (1979-1988) to assess trends.
Purpose of the Study:
- To audit the uptake of invasive cardiological investigations and cardiopulmonary bypass procedures.
- To estimate the annual need for procedures like coronary angiography and myocardial revascularisation within the district.
- To compare district utilization with national requirements and targets.
Main Methods:
- Retrospective audit of invasive cardiology and cardiopulmonary bypass procedures.
- Analysis of data from 1979 to 1988 for the North West Surrey Health District.
- Calculation of district-specific needs and comparison with national estimates based on standardized mortality ratios and catchment areas.
Main Results:
- Continuous growth in procedure uptake was observed throughout the decade.
- Estimated annual district needs: 111-171 coronary angiograms and 63-96 myocardial revascularisation procedures.
- National requirements estimated at 690-1070 coronary angiograms and 390-600 coronary artery bypass grafts per million population annually.
- An additional national requirement for 70 valvar heart operations and 30 miscellaneous procedures per million population annually.
- Delays in service provision led to 20 cardiovascular deaths among patients on waiting lists.
- The UK's 1990 target was 300 coronary artery bypass procedures per million population.
Conclusions:
- Invasive cardiology procedure utilization showed consistent growth over the audited period.
- Significant discrepancies exist between district/national requirements and provision, with potential for unmet needs.
- Patient deaths occurred due to delays in accessing necessary cardiac investigations and surgeries.
Abstract:
The uptake of invasive cardiological investigation and cardiopulmonary bypass procedures by the North West Surrey Health District was audited over the years 1979-88. Growth was almost continuous throughout the ten year period. The need within the district each year for coronary angiography seemed to be between 111 and 171 and for surgical revascularisation of the myocardium between 63 and 96 procedures; the first figure is the mean of the second quinquennial period (1984-88) and the second figure the total for 1988. After correction for the standardised mortality ratio and catchment area, the national requirement should lie between 690 and 1070 coronary angiograms and 390 and 600 coronary artery bypass graft operations per million population each year. There is a further national requirement for 70 valvar heart operations and 30 miscellaneous procedures per million population each year. Owing to delays in the provision of services, 20 patients died of a cardiovascular cause while they were on the waiting list for investigation or surgery. In the United Kingdom the annual target to be achieved by 1990 was 300 coronary artery bypass procedures per million population.