Resource allocation for chronic stable angina: a systematic review of effectiveness, costs and cost-effectiveness of alternative interventions.

Abstract

T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Acute Sector Panel and funded as project number 93/01/02. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will, in England, be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Ageism in cardiology

“…Clinical guidelines should be developed and regularly updated to enable clinicians to make more informed decisions about treating older people, and access to investigations and treatments should be monitored centrally 28. These developments may be given impetus in the United Kingdom by the recently established National Institute for Clinical Excellence and internationally by the emphasis on clinical governance.…”

Beating heart against cardioplegic arrest studies (BHACAS 1 and 2): quality of life at mid-term follow-up in two randomised controlled trials

“…defined by symptoms or by investigations prompted by symptoms) increases the overall frequency of such events, as illustrated in cohorts of patients undergoing coronary artery bypass grafting (CABG) recruited to RCTs of CABG vs. PTCA. 3 Quality of life instruments such as the Seattle Angina Questionnaire (SAQ) provide more sensitive measurements of symptoms and the impact of symptoms on activities of daily living, not least because the outcome is a continuous score rather than an event. On physiological grounds, symptoms of ischaemia are likely to precede events that are themselves attributable to coronary disease.…”

International review of the utilisation and cost of percutaneous transluminal coronary angioplasty

“…In the UK, only a small proportion of patients receives PTCA or CABG compared to patients in other countries [38]. This may be a result of the fact that many patients are not referred to specialists and those that are referred end up on long waiting lists.…”

“…This may be a result of the fact that many patients are not referred to specialists and those that are referred end up on long waiting lists. A survey of GP records in Nottingham found that in patients presenting to their GP with angina as defined by the prescription of nitrates, fewer than 20% were referred to hospital and, of these, half were seen by a cardiologist and only 4% underwent angiographic investigation [38,39]. A questionnaire sent to GPs in Hampshire found that 80% of GPs reported referring 10% or fewer of their patients with angina to a cardiologist, and 72% reported referring 25% or fewer to a hospital physician [38,40].…”

“…A survey of GP records in Nottingham found that in patients presenting to their GP with angina as defined by the prescription of nitrates, fewer than 20% were referred to hospital and, of these, half were seen by a cardiologist and only 4% underwent angiographic investigation [38,39]. A questionnaire sent to GPs in Hampshire found that 80% of GPs reported referring 10% or fewer of their patients with angina to a cardiologist, and 72% reported referring 25% or fewer to a hospital physician [38,40]. A recent study by Hemingway et al [41] highlights that the underuse of coronary revascularisation in the UK is associated with adverse clinical outcomes.…”