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Age- and sex-related utilisation of cardiac procedures and interventions: a multicentric study in Italy
Antonio Boccia1, Gianfranco Damiani, Marcello Maria D'Errico
1University of Rome La Sapienza, Rome, Italy.
Insights
Older patients in Italy receive fewer cardiac procedures like angioplasty and thrombolysis, but more pacemakers. Age, not sex, significantly influences cardiac intervention utilization, suggesting potential age-based discrimination.
Area of Science:
- Cardiology
- Geriatrics
- Health Services Research
Background:
- Cardiovascular diseases are the leading cause of death and disability in Italy, particularly among the elderly.
- Understanding age and sex influences on cardiac procedure utilization is crucial for equitable healthcare.
Purpose of the Study:
- To investigate how patient age and sex affect the utilization of cardiac procedures and interventions in Italy.
Main Methods:
- Retrospective analysis of 2805 patient records from cardiology, internal medicine, and elderly clinics across six Italian regions (1996-1997).
- Examined utilization of coronary catheterisation (CC), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass grafting (CABG), thrombolysis (THR), and permanent pacemaker (PPM) implantation.
Main Results:
- Older patients (>75 years) were significantly less likely to undergo CC (OR=0.062), PTCA (OR=0.093), and THR (OR=0.264).
- Conversely, older patients had a higher likelihood of receiving PPM implantation (OR=3.45 for 65-74 years, OR=7.77 for >75 years).
- No statistically significant differences in utilization were found based on patient sex for any procedure.
Conclusions:
- Clinical management of cardiac disease in older Italian patients may differ significantly from younger patients.
- Age-based discrimination is a potential explanation for observed disparities in cardiac intervention utilization.
Background:
Cardiovascular diseases represent the leading cause of death in Italy and one of the most frequent cause of disability in the elderly. The aim of the study was to investigate the influence of age and sex of patient on the utilisation of cardiac procedure and interventions in Italy.
Methods:
Retrospective analysis of 2805 patients' medical case notes in cardiology, internal medicine and elderly clinics in six Italian Regions during the period 1996-1997, considering coronary catheterisation (CC), percutaneous transluminal coronary angioplasty (PCTA), coronary artery bypass grafting (CABG), thrombolysis (THR) and permanent pacemaker (PPM) implantation.
Results:
Older patients (more than 75 years old) were less likely to undergo CC (OR=0.062). Trends for age and sex did not achieve significance for CAGB (OR=0.815 for older patient). Age is a strong predictor of receiving PTCA, with the oldest group of patients being discriminated (OR=0.093 for people older than 75 years), and the same trend was observed for THR (OR=0.264 for patients older than 75 years). For PPM, older patient has a higher likelihood of receiving this type of intervention (OR=3.45 for 65-74 years, and OR=7.77 for patients older than 75 years). As far as gender of patients is concerned, statistically significant differences for all cardiac procedures or interventions considered were not found.
Conclusions:
Clinical management of older patients with cardiac disease in Italy may be different from that of younger patients. One possible explanation would be that these patients are being discriminated against mainly because of their age.
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