RATING THE URGENCY OF CORONARY ANGIOGRAPHY - RESULTS OF AN EXPERT PANEL PROCESS

OBJECTIVE: To rate the urgency of coronary angiography for patients wi th ischemic heart disease. Ratings were made for patients with varying degrees of symptoms and noninvasive cardiac test results. DESIGN: A p anel of 10 cardiologists rated 354 case scenarios which presented vary ing combinations of clinical factors that may affect urgency. MEASUREM ENTS: The case scenarios were rated by each panelist on a waiting time scale consisting of six categories which ranged from the requirement for emergency angiography to a delay of up to three months. A seventh category represented the lack of urgent need for angiography. The cont ribution of each clinical factor to urgency of coronary angiography wa s determined. MAIN RESULTS: Symptom class as defined by a modification to the Canadian Cardiovascular Society grading scale for angina pecto ris, results of exercise stress tests and results of imaging studies w ere the major determinants of urgency. In cases of unstable angina, re st electrocardiography is of importance. These factors explained at le ast 95% of the variance in the case urgency scores. There was agreemen t by at least five of the panelists on urgency score in 84% of cases. The assigned urgency varied from 6.7, representing no urgent need for angiography, for minimally asymptomatic angina with no positive noninv asive test results, to immediate aniography for cardiogenic shock. Oth er factors had minimal or negligible effects on urgency. CONCLUSIONS: The urgency of need for coronary angiography was addressed by an expli cit method incorporating the jugdements of a panel of expert cardiolog ists, permitting derivation of a scoring system for rating priority of individual patients in the face of waiting lists. These methods illus trate an approach to problems presented by procedure waiting lists.