VARIATIONS IN USE OF CARDIOLOGY SERVICES IN A HEALTH AUTHORITY - COMPARISON OF CORONARY-ARTERY REVASCULARIZATION RATES WITH PREVALENCE OF ANGINA AND CORONARY MORTALITY

Objective: To explore the relation between rates of coronary artery re vascularisation and prevalence of angina to assess whether use of heal th services reflects need. Design: Prevalence of angina symptoms deter mined by postal questionnaire on 16 750 subjects (18 to 94 years), Com parison of data on use of coronary artery revascularisation with preva lence of symptoms and mortality from coronary heart disease. Setting: Health authority with population of 530 000. Subjects: Patients admitt ed to hospital for coronary heart disease; patients who died; and pati ents undergoing angiography, angioplasty, or coronary artery bypass gr aft Cohort of 491 people with symptoms from survey. Main outcome measu res: Pearson's product moment correlation coefficients for relation be tween variables. Results: Overall, 4.0% (95% confidence interval 3.7% to 4.4%) of subjects had symptoms, Prevalences varied widely between e lectoral wards and were positively associated with Townsend score (r = 0.79; P < 0.001), as was mortality, but the correlation between admis sion rates and Townsend score was less clear (r = 0.47; P < 0.01), Rev ascularisation rate and Townsend score were not associated. The ratio of revascularisation to number experiencing symptoms was inversely rel ated to Townsend score (r = -0.67; P < 0.001), The most deprived wards had only about half the number of revascularisations per head of popu lation with angina than did the more affluent wards, In affluent wards 11% (13/116) of those with symptoms had coronary angiograms compared with only 4% (9/216) in poorer wards (chi(2) = 4.96; P = 0.026). Towns end score also inversely correlated with revascularisations per public health premature death from coronary heart disease Carol Saul, (r = - 0.55; P < 0.01) and revascularisations per admission for myocardial in farction (r = -0.47; P < 0.01). Conclusion: The use of interventional cardiology services is not commensurate with need, thus exhibiting the inverse care law.