Evidence for age-based rationing in a Swiss university hospital.
OBJECTIVE
To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today.


METHODS
We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into two age groups; patients aged less than 75 years and those equal to or older than 75 years.


RESULTS
Our main findings were a significant underuse of stress tests (p < 0.001) and coronary angiography (p < 0.0001) in elderly patients with ACS and a significant underuse of echocardiography (p < 0.0001) in patients with CHF of the same age group. In patients with ACS, there was also a trend towards underuse of statins in elderly patients with hypercholesterolaemia. In addition, we noted that the use of beta-blockers in ACS and of ACE inhibitors in CHF was better than in previous published studies but that many patients were still not treated according to evidence based medicine.


CONCLUSIONS
The lower rates of diagnostic tests performed and the lower statin use observed in elderly patients suggest "hidden" rationing of health care in elderly patients.
Jenni
D
D
Division of Cardiology, University Hospital, Basel, Switzerland.
Osterwalder
R
R
Osswald
S
S
Buser
P
P
Pfisterer
M
M
D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D005260:Female; D015276:Health Care Rationing; D006300:Health Services Misuse; D006333:Heart Failure / Q000628:therapy*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013557:Switzerland; D013577:Syndrome