Many angina patients miss out on X-ray tests

MedWire News: Many people with suspected angina do not receive appropriate X-ray tests, and are therefore at increased risk of serious heart problems, UK researchers have found.

"Equitable access to health care is a widely accepted goal for health services internationally and a key principle of the National Health Service," explain Professor Gene Feder, from the University of Bristol, and colleagues.

However, they add: "Most, but not all, studies suggest that older people, women, ethnic minorities, and those who are socioeconomically deprived have less access to effective interventions for stable angina or acute coronary events."

To investigate further, the team studied 10,634 patients with suspected stable angina - chest pains after exertion - who attended six clinics in England between January 1996 and December 2002. The participants were monitored for an average of 3 years.

An independent panel of doctors was asked to review each patient's medical records and found that 1375 of the participants were eligible for coronary angiography - an X-ray examination that shows the extent of artery narrowing around the heart.

The researchers found that, overall, 69% of patients who were deemed eligible for coronary angiography did not receive the test.

Analysis confirmed that people over the age of 65 years, women, south Asian patients, and those in the most deprived sections of the population were significantly less likely to receive coronary angiography than those aged under 50 years, men, White patients and affluent patients.

Consequently, deaths from heart disease and hospital admissions for heart attacks and unstable angina were significantly more common in patients who had not undergone coronary angiography than in those who had received the test.

"Despite the strong emphasis on fairness of access to cardiac investigation in the UK national service framework for coronary heart disease published in 2000, we found that older people, women, and south Asians who were deemed appropriate for coronary angiography were significantly less likely to receive the investigation," write Professor Feder and team in the British Medical journal.

They conclude: "Our findings and those of previous studies should inform policy to deal with sources of inequity in the provision of cardiac services."