Seven in ten patients are missing out on test for early heart disease
Publication Date:25/04/2008
Many people with early symptoms of heart disease are not being given a test that could help reduce their risk of heart attack and other serious problems, a new study has found. Women, people over 65, south Asian patients and the poor are the most likely to miss out.
What do we know already?
One of the early signs of heart disease is a type of chest pain called angina. It happens because the heart isn't getting enough oxygen, usually because the arteries that supply the heart with blood have become narrow and hard.
Angina is called stable if it comes on when you exert yourself and goes away when you rest. If it happens without you doing very much and lasts up to an hour it's called unstable. Angina is a warning that you could have a heart attack.
If your GP thinks you have angina you'll usually be referred to a chest pain clinic, where cardiologists will check what's causing the pain. One test for suspected angina is called an angiogram. It involves doctors putting a thin tube (called a catheter) through an artery into your heart. Then they inject dye through the tube, into the arteries around the heart, to see how narrow they are. People whose arteries are very narrow can have a procedure to widen them (called angioplasty), or they might be referred for bypass surgery for surgeons to replace the blocked arteries with healthy ones.
The present study was done to find out if patients had equal access to this test and also, if having the test earlier made any difference to people's health in the years afterwards.
What does the new study say?
The new study found that 7 out of 10 people who were judged to be suitable for an angiogram did not have one. People over 65, women, south Asian patients, and those in the most deprived fifth of the population were less likely to have the test.
It also found that, if you have angina, having an angiogram nearly halves the likelihood of serious heart problems later. This is likely to be because patients with heart disease detected by an angiogram got appropriate treatment at an early stage.
Tell me more about the study's findings
The researchers studied 10,634 people with suspected stable angina who were attending chest pain clinics, over a period of six years.
An independent panel of doctors found that 1,375 of these patients needed an angiogram. Patients were followed up three years later to find out if their heart disease had progressed.
During the five years after they were diagnosed with angina, nearly 20 in 100 people who did not have an angiogram died from heart disease, or were admitted to hospital with a heart attack or unstable angina. Only 11 in 100 people who had an angiogram went on to have serious heart problems.
The researchers aren't sure why some people are being given angiograms and others aren't. It could be that some patients who are advised to have the test refuse to do so. But they say that better guidance is needed to help doctors decide which people with chest pain could benefit from having the test.
Where does the study come from?
The study was done by researchers from University College London and Queen Mary, University of London, the University of Bristol, and Barts and the London NHS Trust. It was published online first in the BMJ (British Medical Journal).
How reliable are the findings?
This was a good study which followed a large number of people for a long enough time to see the impact of angiography on their future health. One thing that the researchers didn't look at was whether there were differences in people being referred by GPs to the chest pain clinics. This might make the results of who was getting angiography less reliable.
What does this mean for me?
If you have suspected angina or have recently started to get chest pain then this study is important for you. The findings show that not having an angiogram doubles your chances of getting serious heart problems.
What should I do now?
If you have chest pain, or have recently been told you have angina and you haven't had an angiogram, you might want to talk your doctor about whether this test is suitable for you. This will give you a chance to talk about what the test involves and what the benefits and drawbacks for you might be.
If you do have the test and it shows you have heart disease, you'll be able to talk to your doctor about the right treatments to prevent it getting worse. You might be given medicines to reduce high blood pressure or cholesterol if you have these problems. You'll be given advice about diet, exercise and smoking. And you may be referred for an operation if doctors think you need one. All these things can reduce your risk of having a heart attack or stroke.
From:
Sekhri N, Timmis A, Chen R, et al. Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. BMJ. Published online 24 April 2008.
To learn more, see our information on angina.
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