Audit of prioritisation for coronary revascularisation procedures: implications for rationing.

OBJECTIVE

to audit prioritisation of patients awaiting coronary revascularisation.

DESIGN

the case records of 92 Christchurch patients referred for coronary artery bypass surgery (CABG) or percutaneous transluminal angioplasty (PTCA) from January to April 1990 were reviewed. The actual waiting time was compared with a nominally optimal waiting time, determined from an urgency rating score based primarily on severity of angina and coronary anatomy.

RESULTS

of 56 patients referred for CABG, 47 had left main or multivessel disease including proximal stenosis of the left anterior descending artery. Fifty had Canadian class III or IV angina and 18 had impaired left ventricular function. At the time of review (January 1991), 16 had not yet had an operation. The mean waiting time was at least 163 (SD 116) days. Only nine (16%) had CABG within the maximum optimal time. Thirty-six patients had PTCA within eight months, mean waiting time 80 (53) days. These patients had less severe disease, but similar severity of angina. Nineteen (53%) had their procedure within the optimal period.

CONCLUSION

waiting times for coronary revascularisation are excessive, even for high risk patients. Prospective monitoring of the waiting list using a standardised urgency rating score is likely to provide useful information on the dynamics of the waiting list for coronary revascularisation. Furthermore, the effects of further rationing of services can be analysed.