Test for early stage heart disease underused

Test for early stage heart disease underused

According to a study published on bmj.com, 70% of patients with suspected angina do not receive the correct testing and thus have an increased risk of developing serious heart complications. Those patients who are most likely to miss testing include women, elderly people, ethnic minorities, and people with lower incomes.

Angina is a condition characterized by chest pain due to a lack of blood and oxygen supply to the heart (ischemia). It is often preceded by atherosclerosis of the coronary arteries (hardening or narrowing of the arteries).

To analyze the extent and severity of the narrowing of coronary arteries, patients usually receive a coronary angiography x-ray examination. Professor Gene Feder (University of Bristol) and colleagues set out to investigate whether patients had equal access to coronary angiography. There is risk that the long term health of patients may be affected if they do not have an angiography during heart disease's early stage of suspected stable angina (when patients have chest pains due to exertion).

Between January 1996 and December 2002, Feder and colleagues analyzed 10,634 patients with suspected stable angina in six chest pain clinics in England. Patients had chest pain and no known coronary heart disease, and they were of white and south Asian origin. A panel of doctors determined that 1,375 should receive an angiography. Three years later, the patients were followed up to track the development and progression of heart disease. Conditions such as developing unstable angina, suffering a heart attack, and other heart related problems were noted.

The researchers found that 69% of patients who should have had an angiography did not receive one. Elderly patients (over 65 years of age), women, south Asians, and those in lowest quintile (20%) of the income distribution were less likely to receive an angiography test than patients who were less than 50 years old, men, white, and living in relatively higher income areas, respectively. In addition, the group who did not have the test was more likely to die from heart disease and be admitted to hospitals for heart attacks and unstable angina.

The authors suggest the possibilities of different referral methods and patient's selecting to not receive the angiography as explanation for these findings. However, they conclude that, "There is a role for further qualitative research to elucidate why patients who are deemed appropriate for coronary angiography do not receive it."

Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris

Neha Sekhri, Adam Timmis, Ruoling Chen, Cornelia Junghans, NiamhWalsh, Justin Zaman, Sandra Eldridge, Harry Hemingway, Gene Feder

BMJ. (April 2008)


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Section Issues On Medicine: Cardiology