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Age and sex-related bias in the management of heart disease in a district general hospital

Age and sex-related bias in the management of heart disease in a district general hospital
Age and sex-related bias in the management of heart disease in a district general hospital
Objective: to investigate the clinical management of heart disease and determine whether there was age- and sex-related bias in the use of investigations and interventions.Design: retrospective analysis of individual patient records against criteria of appropriateness based on published guidelines, clinical practice and literature relevant to the 1996-7; study period.Setting: a single, district general hospital in London, serving a population of 185 000 people.Subjects: general medical, elderly medical, and cardiology inpatient, and patients attending elderly medical and cardiology outpatient clinics as new referrals between 1 April 1996 and 31 March 1997.Results: we located case notes of 1790 of the 1975 subjects eligible for the study: 911 (51%) were outpatients and 51% were men. Patients aged <75 were significantly more likely than patients aged >= 75 years to be given thrombolysis after an acute myocardial infarction, to be given secondary prevention with aspirin and beta-blockers, to undergo exercise testing and coronary angiography, and to receive an echocardiogram. Men were also significantly more likely than women to have these investigations and interventions as well as to receive an angiotensin-converting enzyme inhibitor when left ventricular dysfunction was identified. Investigations and interventions were underused at all ages.Conclusion: as well is identifying age and sex bias, we found the underuse of investigations and interventions in all age groups in this district general hospital. Should similar patterns of care be found elsewhere, the delivered of high-quality care in an equitable manner (as identified by the National Service Framework for coronary heart disease) may require considerably more resources than have been allocated.
age, management of heart disease, sex
0002-0729
37 - 42
Dudley, Nigel J.
0f0aec69-9cba-4203-a268-53b57fc8e2aa
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Bond, Matthew
af8c8608-71cf-488b-b4cd-d14d5725dfcd
McKee, Dorothy
c667f793-5c82-4543-b3b7-53300bf7c84a
Scott, Marie McClay
740785b6-fbda-4d3e-8639-11d38da5d2f9
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Elder, Andrew T.
f539b448-3b06-40a2-a47a-85f82d1268da
Martin, A. Tony
9edc12fe-c1c4-49a5-a032-bcfd3ca6894f
Blackman, Iva
867fa9f0-b210-40c3-9ccc-456d8f7494fe
Dudley, Nigel J.
0f0aec69-9cba-4203-a268-53b57fc8e2aa
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Bond, Matthew
af8c8608-71cf-488b-b4cd-d14d5725dfcd
McKee, Dorothy
c667f793-5c82-4543-b3b7-53300bf7c84a
Scott, Marie McClay
740785b6-fbda-4d3e-8639-11d38da5d2f9
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Elder, Andrew T.
f539b448-3b06-40a2-a47a-85f82d1268da
Martin, A. Tony
9edc12fe-c1c4-49a5-a032-bcfd3ca6894f
Blackman, Iva
867fa9f0-b210-40c3-9ccc-456d8f7494fe

Dudley, Nigel J., Bowling, Ann, Bond, Matthew, McKee, Dorothy, Scott, Marie McClay, Banning, Adrian, Elder, Andrew T., Martin, A. Tony and Blackman, Iva (2002) Age and sex-related bias in the management of heart disease in a district general hospital. Age and Ageing, 31 (1), 37 - 42. (doi:10.1093/ageing/31.1.37). (PMID:11850306)

Record type: Article

Abstract

Objective: to investigate the clinical management of heart disease and determine whether there was age- and sex-related bias in the use of investigations and interventions.Design: retrospective analysis of individual patient records against criteria of appropriateness based on published guidelines, clinical practice and literature relevant to the 1996-7; study period.Setting: a single, district general hospital in London, serving a population of 185 000 people.Subjects: general medical, elderly medical, and cardiology inpatient, and patients attending elderly medical and cardiology outpatient clinics as new referrals between 1 April 1996 and 31 March 1997.Results: we located case notes of 1790 of the 1975 subjects eligible for the study: 911 (51%) were outpatients and 51% were men. Patients aged <75 were significantly more likely than patients aged >= 75 years to be given thrombolysis after an acute myocardial infarction, to be given secondary prevention with aspirin and beta-blockers, to undergo exercise testing and coronary angiography, and to receive an echocardiogram. Men were also significantly more likely than women to have these investigations and interventions as well as to receive an angiotensin-converting enzyme inhibitor when left ventricular dysfunction was identified. Investigations and interventions were underused at all ages.Conclusion: as well is identifying age and sex bias, we found the underuse of investigations and interventions in all age groups in this district general hospital. Should similar patterns of care be found elsewhere, the delivered of high-quality care in an equitable manner (as identified by the National Service Framework for coronary heart disease) may require considerably more resources than have been allocated.

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More information

Published date: January 2002
Keywords: age, management of heart disease, sex
Organisations: Faculty of Health Sciences

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Local EPrints ID: 334680
URI: http://eprints.soton.ac.uk/id/eprint/334680
ISSN: 0002-0729
PURE UUID: b69dcbf0-26df-47c0-ae26-eb5e5f28142d

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Date deposited: 22 Mar 2012 12:10
Last modified: 16 Jul 2019 22:09

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Contributors

Author: Nigel J. Dudley
Author: Ann Bowling
Author: Matthew Bond
Author: Dorothy McKee
Author: Marie McClay Scott
Author: Adrian Banning
Author: Andrew T. Elder
Author: A. Tony Martin
Author: Iva Blackman

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