Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications
Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications
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DOI：
10.1136/heart.85.6.680
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发表时间：
2001-06-01
期刊：
影响因子：
5.7
通讯作者：
Blackman, I
中科院分区：
文献类型：
--
作者：
Bowling, A;Bond, M;Blackman, I
目的-评估在一家英国医院的心脏病患者是否有平等的机会进行运动试验、冠状动脉造影和冠状动脉旁路移植术（CABG）。（n = 1790），从患者日期起追溯每例病例12个月和向前12个月：地点-泰晤士地区的一家英国地区医院。患者-患者（择期和急诊）在出院或死亡时有心脏ICD住院代码，或在1996- 1997年12个月内被转诊到心脏科或老年病房护理的患者结果-对1790例医院病例记录的分析显示，尽管老年患者的干预指征与年轻患者相同，（即年龄> 75岁）和女性独立地进行运动耐量试验（运动EGG）和心脏导管插入术的可能性明显较低。年龄和接受CABG的相似趋势没有达到显著性。虽然临床优先分数也独立预测心脏导管插入术和CABG，相当数量的患者在高临床优先组没有提到任何procedure.Conclusions -老年患者和女性心脏病的管理和治疗可能是不同的年轻患者和男性。考虑到治疗适应症的相似性以及缺乏作为这些差异原因的显著禁忌症或合并症，一种可能的解释是这些患者主要因其年龄和性别而受到歧视。尽管临床优先级评分独立预测了导管插入和CABG，但高优先级组中的大部分患者未被转诊。这意味着新西兰的优先评分制度可能比联合王国的做法更公平。纠正服务提供方面的这些不公平现象所涉费用将是相当大的。
Objectives - To 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).Method - Retrospective 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.Setting - Single 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.Results - Analysis 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 EGG) 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.Conclusions - The 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.