The appropriateness of use of percutaneous transluminal coronary angioplasty in Spain

Aguilar, M.A.; Fitch, Kate; Lázaro, Pablo; Bernstein, Steven J.

doi:10.1016/s0167-5273(01)00385-0

Cited by 27 publications

(12 citation statements)

References 25 publications

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“…35 Another hypothesis suggested by some authors is that the differential use of coronary revascularisation in women may be less a problem of "underuse" in women than one of "overuse" in men. 16 27 However, we did not find any differences by gender in the proportion of inappropriate revascularisation procedures or "overuse" in our study, 15 nor did a US study find significant differences between men and women in the proportion of inappropriate revascularisation procedures. 36 Another area of possible differences between the sexes relates to prognosis, although this is a controversial subject.…”

Section: Discussioncontrasting

confidence: 52%

Gender differences in clinical status at time of coronary revascularisation in Spain

Aguilar

2002

Journal of Epidemiology &Amp; Community Health

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Objective: To study gender differences in clinical status at the time of coronary revascularisation. Design: Retrospective study of clinical records. Two stage stratified cluster sampling was used to select a nationally representative sample of patients receiving a coronary revascularisation procedure in 1997. Setting: All of Spain. Main outcome measures: Odds ratios (OR) in men and women for different clinical and diagnostic variables related with coronary disease. A logistic regression model was developed to estimate the association between coronary symptoms and gender. Results: In the univariate analysis the prevalence of the following risk factors for coronary heart disease was higher in women than in men: obesity (OR=1.8), hypertension (OR=2.9) and diabetes (OR=2.1). High surgical risk was also more prevalent among women (OR=2.6). In the logistic regression analysis women's risk of being symptomatic at the time of revascularisation was more than double that of men (OR=2.4). Conclusions: Women have more severe coronary symptoms at the time of coronary revascularisation than do men. These results suggest that women receive revascularisation at a more advanced stage of coronary disease. Further research is needed to clarify what social, cultural or biological factors may be implicated in the gender differences observed. Many studies have shown large variations in the use of health services by such sociodemographic variables as social class, income, educational level, race or gender.1-7 Gender has traditionally been used as a potential confounding factor in most studies of health inequalities, but recent studies suggest that it may be predictive of health services use.5 8 In general, women have poorer perceived health status than men, with higher morbidity and greater use of primary health care services. For the same level of morbidity, however, women tend to use fewer hospital services than do men. 5Cardiovascular disease, and particularly coronary heart disease, is one of the most prevalent health conditions in the developed world. Coronary disease has classically been considered a man's disease, in part because it appears later in women than in men. Despite the fact that mortality rates in men are considerably higher than those in women, however, women's longer life expectancy means that the number of deaths from coronary disease in the developed countries is about the same in both sexes.9 Given the huge social and health implications of coronary disease, large amounts of resources have been allocated for its treatment in recent years, with particular attention to providing equipment and improving hospital infrastructure for the performance of the two most widely used procedures for coronary revascularisation: percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG).Whether or not women truly have poorer access to diagnostic and therapeutic procedures for coronary disease is a subject of debate in the scientific literature. A number of studies have shown that wome...

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Section: Discussioncontrasting

confidence: 52%

Gender differences in clinical status at time of coronary revascularisation in Spain

Aguilar

2002

Journal of Epidemiology &Amp; Community Health

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“…Although several studies have found a positive relationship between the volume of cardiac procedures and better outcomes both in Korea and in other countries [16,30], the relationship with appropriateness rate has not been thoroughly investigated. A recent study in Spain found that hospital characteristics were not important for overall appropriateness [20], but the appropriateness rate for cardiac revascularization was higher in 'areas' with higher usage rates [7]. The findings of this study suggest that an increased volume of a procedure might be accompanied with more appropriateness in the decision to perform the procedure as well as the success rate.…”

Section: Discussionmentioning

confidence: 56%

“…In a study conducted in The Netherlands on 3270 patients, the ratings of procedures as appropriate, uncertain, and inappropriate were 39%, 31%, and 29%, respectively [18]. An appropriateness study in Sweden assessed 32% of procedures as appropriate, 30% as uncertain, and 38% as inappropriate [19]; and in Spain the results were 46% appropriate, 31% uncertain, and 22% inappropriate [20].…”

Section: Introductionmentioning

confidence: 99%

The appropriateness of percutaneous transluminal coronary angioplasty in Korea

Yim¹,

Khang²,

Oh³

et al. 2004

International Journal of Cardiology

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“…3 Around the world, overuse of some individual services may be as high as 80% of cases (see Figure 2: Overuse of Selected Services in Four Countries). 4 While overuse has been best documented in high-income countries (HICs), low- and middle-income countries (LMICs) are not immune, and evidence suggestive of widespread overuse is accumulating from countries and health systems as diverse as Australia, 5 Spain, 6 Israel, 7 Brazil, 8 and Iran. 9 Overuse can coexist with unmet health needs, particularly in LMICs.…”

Section: Introductionmentioning

confidence: 99%