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Variation in purchasing for the invasive management of coronary heart disease

D J Gunnell1, I Harvey

  • 1Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR.

Public Health
|January 1, 1996
PubMed

Insights

Purchasing of invasive cardiac procedures like coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) varied widely across UK health authorities. These variations did not correlate with coronary heart disease mortality rates.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Public Health Policy

Background:

  • Coronary heart disease (CHD) management involves invasive procedures like coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), and diagnostic coronary angiography.
  • Significant regional variations in healthcare provision can impact patient outcomes and resource allocation.

Purpose of the Study:

  • To investigate variations in the purchasing of key invasive cardiac interventions and diagnostic procedures across UK health authorities.
  • To explore relationships between purchasing patterns, local service availability, and population health needs defined by CHD mortality.
  • To identify planned service developments in cardiology.

Main Methods:

  • A postal questionnaire survey was conducted among Directors of Public Health in UK health authorities (as of March 1994).
  • Data collected included purchasing rates for CABG, PTCA, and coronary angiography, alongside information on planned cardiology service developments.
  • Response rate was 62%.

Main Results:

  • Mean rates per million population: CABG 374 (range 162-710), PTCA 183 (range 18-648), coronary angiography 1,010 (range 581-2,334).
  • The ratio of invasive treatment (CABG + PTCA) to angiography was approximately 1:2.
  • Variations in provision were not associated with CHD mortality rates or the presence of local providers.
  • Higher purchasing of CABG correlated with higher purchasing of PTCA (Spearman's r = 0.52).
  • Greatest purchasing variations were observed for PTCA, an intervention with an evolving role in CHD management.

Conclusions:

  • Observed variations in purchasing invasive cardiac treatments and investigations do not align with population needs as indicated by CHD mortality rates.
  • The significant variability in PTCA purchasing highlights the need for clearer consensus guidelines.
  • Development of consensus guidelines for the appropriate use of these interventions and for defining population needs is essential.

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