ArticleJournal of general internal medicine
Placing patients in the queue for coronary surgery: do age and work status alter Canadian specialists' decisions?
Article in Journal of general internal medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Pooled it
- Triage for coronary artery bypass graft surgery in Canada: do patients agree on who should come first?BMC health services research · 2007Article
- The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients.BMC health services research · 2007Article
- Waiting times and prioritization for coronary artery bypass surgery in New Zealand.Heart (British Cardiac Society) · 1999Article
- A comparison of cardiovascular procedure use between the United States and Canada.Health services research · 1998Article
- Analysis of deaths while waiting for cardiac surgery among 29,293 consecutive patients in Ontario, Canada. The Steering Committee of the Cardiac Care Network of Ontario.Heart (British Cardiac Society) · 1998Article
- Predictors for waiting time for coronary angioplasty in a high risk population.Quality in health care : QHC · 1995Article
- Good judgement or sex bias in the referral of patients for the diagnosis of coronary artery disease? An exploratory study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 1995Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the effects of age and work status on whether and where cardiovascular specialists would place hypothetical patients in the queue for coronary surgery. MATERIALS AND
methodsMailed survey presenting a set of clinical scenarios either to be rated on a scale with 7 time frames for urgency of need or to be designated as questionable/inappropriate for intervention. The basic scenario was a patient with mild-moderate stable angina, good left ventricular function, and limited coronary disease; operative risks and stress test results were varied. Three identifiers were used: "45-year-old civil servant gainfully employed"; "45-year-old laborer disabled by angina, faces job loss"; and "75-year-old retiree, angina limits golf."
participantsCardiologists and cardiac surgeons practicing in five Ontario medical centers (n = 120).
resultsThere was a 59% response rate (120 usable responses). Large shifts in willingness to intervene occurred in favor of the disabled laborer (p less than 0.0001) and against the retiree (p-value ranges from 0.04 to less than 0.0001, depending on operative risk and stress test results), but not for the employed civil servant. Striking effects (p less than 0.0001) were also evident in ratings of waiting time, with the order of priority being the disabled laborer first, the civil servant second, and the retiree last. The overall mean shift due to work status or age was equal to, or larger than, the mean shift due to clinical factors, such as stress test results, changes in severity of stable angina, and extent of coronary disease.
conclusionCardiovascular specialists may place considerable weight on age and work status in determining urgency and appropriateness of coronary revascularization. Risk-benefit concerns may partly explain shifting thresholds for intervention, but not differential waiting times. The influence of these factors should be sought in utilization audits and addressed from an ethical perspective.
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Registered trials
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