Related Experiment Videos
Are the economically active more deserving?
1Department of Public Health Medicine, Eastern Health and Social Services Board, Belfast.
Insights
Economically inactive patients waited twice as long for coronary angiography compared to active patients. This suggests non-clinical factors may influence doctors' decisions on revascularisation assessment for angina.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Coronary angiography is a key diagnostic tool for assessing coronary artery disease.
- Timely intervention is crucial for managing angina and preventing adverse cardiac events.
Purpose of the Study:
- To explore the relationship between the duration of medical management before coronary angiography and patient demographics.
- To identify non-clinical factors influencing referral decisions for revascularisation assessment.
Main Methods:
- Systematic review of a random sample of 500 patients undergoing their first coronary angiography.
- Analysis adjusted for clinical case mix and demographic variables.
Main Results:
- After adjustment, economically inactive patients had a mean medical management duration twice as long as economically active patients.
- Multiple regression analysis confirmed a significant association (beta = 0.44, P < 0.0001).
Conclusions:
- Non-clinical factors, such as economic activity status, may influence physician decisions regarding revascularisation assessment for angina.
- These findings highlight potential inequities in access to timely cardiac interventions.
Objective:
To investigate the possibility of an association between the duration of medical treatment before coronary angiography and demographic and non-clinical factors.
Design:
A systematic review of a random sample of 500 patients undergoing their first angiographic assessment.
Subjects:
500 cases were selected randomly from patients investigated in 1991 at the two catheterisation centres in Northern Ireland.
Main Outcome Measures:
The duration of medical management before angiography.
Results:
346 had elective and 154 urgent catheterisation. The duration of medical management was adjusted for both case mix (age at onset, body mass index, angina grade, history of myocardial infarction, history of hypertension, diabetes or hyperlipidaemia, treatment intensity) and other demographic variables (sex, smoking status, an indicator of "deprivation", and distance of the patient's area of residence from the hospital). After this adjustment the mean duration of medical management before angiography was twice as long for economically inactive patients as for those who were economically active. In a multiple regression, the relevant beta coefficient was 0.44 (95% confidence interval 0.33 to 0.58, P < 0.0001).
Conclusions:
These results suggest that, in making discretionary decisions about when to refer patients with angina for revascularisation assessment, doctors may be influenced by non-clinical factors unrelated to disease severity.