Report finds unequal access to heart disease test

Nearly seven in ten patients in England who need a test for early stage heart disease do not receive one, a new study claims today.

The British Medical Journal (BMJ) report says people could suffer from serious heart problems as a result.

The groups most affected by the problem include women, older people, the poor and patients from ethnic minorities.

Researchers studied 10,634 patients with suspected stable angina – pains in the chest after exertion – attending six chest pain clinics in England between January 1996 and December 2002.

The study included white and south Asian patients with chest pain and no known coronary heart disease.

The researchers looked at whether patients were given equal access to coronary angiography, a specialist X-ray examination in which a substance is injected into the arteries around the heart to show the extent and severity of the narrowing of the arteries around the heart.

Of the patients studied, 1,375 needed an angiography.

But the researchers claim 69 per cent of patients deemed appropriate for angiography had not had one.

People over 65, women, south Asian patients and those in the most deprived fifth of the population were less likely to receive the test compared with those aged under fifty, men, white patients, and those living in the less deprived areas.

The study also found that deaths from heart disease and admissions for heart attacks and unstable angina were more common in the group who had not had an angiography.

“[Inequalities in angiography access] could reflect differential referral of appropriate patients? [and] some variation in use of coronary angiography might result from patients’ choices not to undergo the procedure, which could vary systematically by demographic group,” the researchers conclude.

They add that further research should be undertaken to determine why patients who are deemed appropriate for coronary angiography do not receive it.