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Variations in the use of coronary angiography in three cities in the Trent Region
1Department of Medicine, University Hospital, Queen's Medical Centre, Nottingham.
Insights
Physician referral patterns for coronary angiography vary, influencing patient treatment. Late referrals ensure intervention but may miss opportunities for early revascularization benefits in mild symptom cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Coronary angiography is a key diagnostic tool for suspected ischaemic heart disease.
- Referral practices and patient characteristics can influence investigation outcomes.
Purpose of the Study:
- To characterize patients undergoing coronary angiography.
- To evaluate the outcomes of coronary angiography investigations.
Main Methods:
- Prospective study conducted across three regional centers (Sheffield, Leicester, Nottingham).
- Involved patients referred for coronary angiography between July 1988 and June 1989.
- Assessed coronary artery disease extent and subsequent interventions.
Main Results:
- Significant variation in patient profiles and referral philosophies observed across centers.
- Nottingham: patients with severe, long-standing angina and extensive treatment; most required intervention.
- Leicester/Sheffield: patients with mild, short-duration angina; fewer interventions despite significant disease.
Conclusions:
- Referral practices for coronary angiography reflect differing physician approaches.
- Late referrals lead to high intervention rates but may delay revascularization benefits for some.
- Opportunities for intervention in mild symptomatic patients with extensive coronary disease may be missed.
Objective:
To establish the characteristics of patients referred for coronary angiography and the outcome of investigation.
Design:
Prospective study.
Setting:
Three regional referral centres at Sheffield, Leicester, and Nottingham.
Patients:
All patients referred for investigation from 1 July 1988 to 30 June 1989.
Interventions:
Coronary angiography for suspected ischaemic heart disease.
Main Outcome Measures:
Site and extent of coronary artery disease at coronary angiography and subsequent intervention.
Results:
There was a range of clinical activity with a trend towards symptomatic control in Nottingham where patients tended to have more severe angina of long duration and extensive drug treatment. Important coronary lesions were often found and most patients needed coronary artery bypass surgery or angioplasty. In Leicester and Sheffield, where angiography was used prognostically, patients tended to have mild angina of shorter duration and less extensive medical treatment; significant coronary disease was often found but fewer patients were recommended for further intervention.
Conclusions:
Referral for coronary angiography seems to reflect philosophical differences among the referring physicians. Referring patients late in the disease process ensures that most have a subsequent intervention but the benefits of revascularisation may be denied to those with mild symptoms but extensive coronary disease.