VARIATION IN PURCHASING FOR THE INVASIVE MANAGEMENT OF CORONARY HEART-DISEASE

This paper reports the results of a postal questionnaire survey of Dir ectors of Public Health in all health authorities in the United Kingdo m (as at March 1994). Our aim was to examine variations in the purchas ing of coronary artery bypass grafting, percutaneous transluminal coro nary angioplasty and coronary angiography. Information on planned serv ice developments in cardiology was also sought. The response rate was 62%. The mean rate of CABG was 374 per million total population (range 162-710); PTCA 183 (range: 18-648); and coronary angiography 1,010 (r ange 581-2,334). The mean ratio of invasive treatment to angiography w as 1:2. Variations in provision were not related to mortality from cor onary heart disease or the availability of a local provider. Those dis tricts purchasing higher levels of CABG tended to purchase higher leve ls of PTCA (Spearman's r = 0.52). Observed variations in purchasing of invasive treatments and investigation for coronary heart disease do n ot relate to population 'need' as defined by mortality rates from CHD. The greatest variations are seen in the purchasing of PTCA, an interv ention whose place in the management of CHD is as yet not fully define d. Consensus guidelines on the appropriate use of these interventions and on population needs are required.