The Use of Coronary Angiography and Coronary Revascularisation Procedures in a Glasgow Population

Kesson, Eileen McKnight (1994) The Use of Coronary Angiography and Coronary Revascularisation Procedures in a Glasgow Population. MSc(R) thesis, University of Glasgow.

Abstract

Aim: To describe and explain variation in the use of coronary angiography and revascularisation in an urban population, in relation to available measures of need: age, gender, mortality and socioeconomic status. Methods: A case was defined as an individual aged 35 - 74, residing in the acute catchment area of the Western Infirmary, Glasgow and undergoing coronary angiography. Data concerning angiography in 1990 and revascularisation in 1990 - 1991, were collected from routine and non routine sources from each of the 3 centres where patients in this area may be investigated. Standardised Mortality Rates for coronary heart disease (ICD 410 - 414) were used as a proxy of need. Socioeconomic deprivation in postcode areas was described using the categories of Carstairs and Morris. Rates of investigation per 1000 population were calculated by age and sex. The number of expected and observed angiograms, the proportion of patients proceeding to revascularisation and the number of days between investigation and surgery were calculated for men and women separately in each deprivation category. Results: 195 men and 95 women aged 35 - 74 were investigated, at a rate of 4.53 and 1.91 per 1000 respectively. No significant difference was demonstrated by age or deprivation category in the number proceeding to revascularisation. The median time between investigation and surgery showed a significant difference; men in the most affluent category waited longer for surgery than men in the middle category. A statistically significant relative excess of coronary investigation was observed in the most affluent category and a significant deficit in more deprived categories. Conclusions: The differences observed in this investigation could not be explained on the basis of need, as indicated by differences in mortality. The greater length of time between investigation and surgery in the most affluent category may reflect earlier referral of this group for investigation, compared to those from more deprived categories. However, careful inspection and analysis of routine data are unable to sort out competing explanations for the different investigation and treatment rates between men and women, age groups and mortality and socioeconomic groups. Additional research is required to explain the variation in referral and the effectiveness, efficiency and appropriateness of care. Health care purchasing decisions could then be made with a view to reducing variations in care which are not based on need or likely benefit from treatment.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Additional Information: Adviser: G CM Watt
• Keywords: Medicine, Medical imaging
• Date of Award: 1994
• Depositing User: Enlighten Team
• Unique ID: glathesis:1994-74673
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 27 Sep 2019 17:14
• Last Modified: 27 Sep 2019 17:14
• URI: https://theses.gla.ac.uk/id/eprint/74673