ARE THE ECONOMICALLY ACTIVE MORE DESERVING

Objective-To investigate the possibility of an association between the duration of medical treatment before coronary angiography and demogra phic and nonclinical factors. Design-A systematic review of a random s ample of 500 patients undergoing their first angiographic assessment. Subjects-500 cases were selected randomly from patients investigated i n 1991 at the two catheterisation centres in Northern Ireland. Main ou tcome measures-The duration of medical management before angiography. Results-346 had elective and 154 urgent catheterisation. The duration of medical management was adjusted for both case mix (age at onset, bo dy mass index, angina grade, history of myocardial infarction, history of hypertension, diabetes or hyperlipidaemia, treatment intensity) an d other demographic variables (sex, smoking status, an indicator of '' deprivation'', and distance of the patient's area of residence from th e hospital). After this adjustment the mean duration of medical manage ment before angiography was twice as long for economically inactive pa tients as for those who were economically active. In a multiple regres sion, the relevant beta coefficient was 0.44 (95% confidence interval 0.33 to 0.58, P < 0.0001). Conclusions-These results suggest that, in making discretionary decisions about when to refer patients with angin a for revascularisation assessment, doctors may be influenced by non-c linical factors unrelated to disease severity.