ArticleHeart (British Cardiac Society)2001
Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications.
Article in Heart (British Cardiac Society), 2001. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed.
- Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7.Journal of the American College of Cardiology · 2022Review
- Extent of coronary atherosclerosis and arterial remodelling in women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation.Cardiovascular diagnosis and therapy · 2018Article
- Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013.Korean circulation journal · 2016Article
- Age and gender differences in the prevalence and patterns of multimorbidity in the older population.BMC geriatrics · 2014Observational
- Propensity analysis of outcome in coronary artery bypass graft surgery patients >75 years old.General thoracic and cardiovascular surgery · 2012Article
- Underrepresentation of elderly people in randomised controlled trials. The example of trials of 4 widely prescribed drugs.PloS one · 2012Article
- Pathways leading to coronary revascularisation among patients with diabetes in Finland: a longitudinal register-based study.BMC health services research · 2011Article
- The influence of socio-demographic characteristics on consultation for back pain--a review of the literature.Family practice · 2011Review
- Equity in access to total joint replacement of the hip and knee in England: cross sectional study.BMJ (Clinical research ed.) · 2010Article
- Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking Turkish men and women with acute myocardial infarction.Clinical cardiology · 2010Article
- Women and ischemic heart disease: evolving knowledge.Journal of the American College of Cardiology · 2009 · on this mapReview
- Sociodemographic variations in the contribution of secondary drug prevention to stroke survival at middle and older ages: cohort study.BMJ (Clinical research ed.) · 2009Article
- What do patients really want? Patients' preferences for treatment for angina.Health expectations : an international journal of public participation in health care and health policy · 2008Article
- Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris.BMJ (Clinical research ed.) · 2008Article
- Age and sex interaction in reported help seeking in response to chest pain.The British journal of general practice : the journal of the Royal College of General Practitioners · 2008Article
- Men: good health and high mortality. Sex differences in health and aging.Aging clinical and experimental research · 2008Review
- Honour your father and mother: ageism in medicine.The British journal of general practice : the journal of the Royal College of General Practitioners · 2007Article
- The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients.BMC health services research · 2007Article
- Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology.Quality & safety in health care · 2007Article
- Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?Journal of cardiothoracic surgery · 2006Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess whether patients with heart disease in a single UK hospital have equitable access to exercise testing, coronary angiography, and coronary artery bypass graft surgery (CABG).
methodRetrospective analysis of patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study.
settingSingle UK district hospital in the Thames Region. PATIENTS: Patients (elective and emergency) with a cardiac ICD inpatient code at discharge or death, or who were referred to cardiology or care of the elderly unit over a 12 month period in 1996-7 (new episodes) were included.
resultsAnalysis of 1790 hospital case notes revealed that, despite having indications for intervention identical to those of younger patients, older patients (that is, those aged > 75 years) and women, independently, were significantly less likely to undergo exercise tolerance testing (exercise ECG) and cardiac catheterisation. The similar trends for age and access to CABG did not achieve significance. While clinical priority scores also independently predicted access to cardiac catheterisation and CABG, considerable numbers of patients in high clinical priority groups were not referred for either procedure.
conclusionsThe management and treatment of older patients and women with cardiac disease may be different from that of younger patients and men. Given the similarity of the indications for treatment and the lack of significant contraindications or comorbidities as a cause for these differences, one possible explanation is that these patients are being discriminated against principally because of their age and sex. Although clinical priority scores independently predicted access to catheterisation and CABG, large proportions of patients in high priority groups were not referred. This implies that the New Zealand priority scoring system may be more equitable than UK practice. The cost implications of redressing these inequities in service provision would be considerable.
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