Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris.
OBJECTIVE
To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates.


METHODS
Multicentre cohort with five year follow-up.


METHODS
Six ambulatory care clinics in England.


METHODS
1375 consecutive patients in whom coronary angiography was individually rated as appropriate with the Rand consensus method.


METHODS
Receipt of angiography (420 procedures); coronary mortality and acute coronary syndrome events.


RESULTS
In a multivariable analysis, angiography was less likely to be performed in patients aged over 64 compared with those aged under 50 (hazard ratio 0.60, 95% confidence interval 0.38 to 0.96), women compared with men (0.42, 0.35 to 0.50), south Asians compared with white people (0.48, 0.34 to 0.67), and patients in the most deprived fifth compared with the other four fifths (0.66, 0.40 to 1.08). Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event.


CONCLUSIONS
At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas. Not receiving appropriate angiography was associated with a higher risk of coronary events in all groups. Interventions based on clinical guidance that supports individualised management decisions might improve access and outcomes.
Sekhri
Neha
N
Cardiac Directorate, Barts and the London NHS Trust, London.
Timmis
Adam
A
Chen
Ruoling
R
Junghans
Cornelia
C
Walsh
Niamh
N
Zaman
M Justin
MJ
Zaman
Justin
J
Eldridge
Sandra
S
Hemingway
Harry
H
Feder
Gene
G
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors