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Chest pain patients at risk says study

By Emma Wilkinson

Seven in ten patients referred by their GP to the chest pain clinic do not undergo coronary angiography, putting their long-term health at risk, a UK study suggests.

Women, older people, patients from ethnic minorities and the poor fare the worst, results from more than 10,000 patients attending six centres show.

The researchers found that 1,375 of the patients in the study needed an angiography but 69% of them had not received one.

Those over the age of 64 years were 40% less likely to have the test than those under 50, women were 58% less likely to have one than men and south Asians were 52% less likely to have the test than white people.

Patients in the most deprived fifth were a third less likely to have an angiography than anyone else.

The researchers also found that not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary events and deaths from heart disease three years later.

Study leader, Professor Gene Feder, professor of primary health care at the University of Bristol, said it was not clear from the results why people were not getting access to angiography but it was likely to be a mixture of factors.

"It may include patient choice and not just be down to whether it's being offered to patients when it's appropriate."

He said GPs needed to remain vigilant after patients had been to the chest pain clinic.

"When patients are referred back to us we still need to review these patients and these symptoms and if we're still concerned refer them back – we are still going to have to be suspicious."

He added that GPs should also enter into discussions with patients who may have chosen not to undergo angiography after it was recommended.

"I don't want to say this is somehow the fault of the clinics – the methods they are using do need further development and that is up to the researchers."

Dr Jonathan Morrell, a GP in Hastings, East Sussex, and a hospital practitioner in cardiology, agreed GPs should be vigilant after patients had been to a chest pain clinic but said angiography was not always the best choice for patients.

‘There are risks associated with angiography: thrombotic break-off, heart attack, stroke, haemorrhage from the entry site and in more extreme cases, death. This is not a test that should be rushed into and should be done according to the risk of the patient,' he said.

BMJ online first 25th April 2008

Heart attack: patients at risk because of lack of testing Heart attack: patients at risk because of lack of testing

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