An audit on access to coronary artery surgery within a health district using New Zealand priority criteria as a benchmark

Abstract

A professional advisory group in New Zealand, consiting of cardiologists, cardiac surgeons and general practitioners have recommended priority criteria for access to Coronary-Artery Bypass Graft (CABG). They used published outcome studies in developing the criteria, and numerical scores were assigned to both biological and social dimensions of ischaemic heart disease. The New Zealand criteria were used to investigate access to services for patients in the UK in Sunderland, Tyne and Wear. Case notes of 229 Sunderland residents who underwent coronary angiography in the 1995–96 financial year were reviewed. The clinical threshold for access to CABG was much higher in Sunderland than in New Zealand. After controlling for the severity of disease, there was no evidence of inequity of access based on age, gender, smoking status or the deprivation indices of the patients' ward of residence. The correlation between the New Zealand Priority Criteria scores and the waiting time for coronary angiography, CABG and Percutaneous Transluminal Coronary Angioplasty (PTCA) was present, but weak ( r = −0.22, −0.1 and −0.54 respectively). The New Zealand consensus criteria proved a useful benchmark both to assess access for patients with ischaemic heart disease to coronary artery surgery in a local Health District and to prioritise patients on the waiting list for coronary artery surgery. They allowed a realistic assessment of access according to age, gender, smoking status and deprivation by taking disease severity into account.