Key result
Regional coronary angiography rates vary widely but show no association with local IHD mortality.
Why the study?
Variations in referral for coronary angiography and their relationship to local coronary artery disease death rates were unclear in Northern Ireland.
Does referral for coronary angiography vary geographically and relate to local death rates from ischaemic heart disease?
Observational (n=5,173)
Yes
Does referral for coronary angiography vary geographically and relate to local death rates from ischaemic heart disease?
There is significant geographic variation in referral rates for coronary angiography that does not correlate with local ischaemic heart disease mortality, suggesting non-uniform referral thresholds.
Answers are grounded in this paper and cite their sources.
Regional angiography variation signals possible access inequities; observational data leave open alignment with clinical need.
OBJECTIVES: To examine variations in referral for coronary angiography within Northern Ireland and relate these to local death rates from coronary artery disease (ICD rubrics 410-414). DESIGN: A descriptive retrospective analysis of aggregate hospital activity data for 1979-88 and corresponding mortality rates in the local population. SETTING: Two regional referral hospitals and 26 local district council areas. PATIENTS: 5173 patients aged 35-74 years with an underlying diagnosis of ischaemic heart disease, whose records contained complete information on their age, sex, and home address. MAIN MEASURES: Age-standardised angiography rates and corresponding standardised death rates derived from the registrar general's reports. RESULTS: Among the 26 constituent district council areas there was significant heterogeneity in the angiography rates, ranging from 62 to 335/100,000 in men and from 7 to 62/100,000 in women (likelihood ratio statistic 856 and 359 respectively). There was no significant association between these angiography rates and the local death rates from ischaemic heart disease. CONCLUSION: The results suggest a non-uniform threshold for referral for angiography. IMPLICATIONS: Clinicians need to examine the appropriate indications for referral for invasive investigation.
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Frank Kee (1993) conducted an observational in ischaemic heart disease (n=5,173). Referral for coronary angiography was evaluated on Age-standardised angiography rates and corresponding standardised death rates from ischaemic heart disease.
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