Impact of Age, Gender and Indigenous Status on Access to Diagnostic Coronary Angiography for Acute Coronary Syndrome

Abstract

Objective:Using the Australian guidelines for themanagementof acute coronary syndromes,we investigated the proportion of eligible patients who received a diagnostic coronary angiogram for ACS in Australian hospitals. Method:Analysis of a prospective nationwidemulticentre health registry. Study cohort: Patients admitted through emergency departments between 1 November 2005 and 31 July 2007; who presented at one of the 39 study sites with high risk non-ST-segment elevated acute coronary syndromes (n= 1764). Outcomemeasure: Theproportionof eligiblepatientswho had diagnostic angiography by Indigenous status, risk profile and gender. Results: Indigenous patients were younger, more likely to be diabetic and smoke tobacco than non-Indigenous patients. Indigenouswomenwere four timesmore likely to smoke than non-Indigenous women. Sixty-five percent of eligiblemen and 50%of eligiblewomen received diagnostic angiography. Indigenous patients were equally likely to get angiography compared to eligible non-Indigenous patients. Age was also a determinant of likelihood of angiography being performed, increasing age reduced the likelihood of angiography. As such, Indigenous patients may be relatively under-treated, although small numbers preclude a firm conclusion. Conclusions:There isa significant shortfall in the receipt of diagnostic angiograms for all groups (men and women, Indigenous and non-Indigenous) between eligibility and receiving an angiogram. This shortfall is most marked for all women compared to men. In light of this finding, we recommend an in depth analysis of any gender difference in diagnostic investigation and management of ACS in Australian hospitals.