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Research article:
The UK National Health Service: Delivering Equitable Treatment Across the Spectrum of Coronary Disease
Reference:
Nathaniel M. Hawkins, Shaun Scholes, Madhavi Bajekal, Hande Love, Martin O’Flaherty, Rosalind Raine, Simon Capewell(2013) The UK National Health Service: Delivering Equitable Treatment Across the Spectrum of Coronary Disease. Circulation: Cardiovascular Quality and Outcomes, doi: 10.1161/CIRCOUTCOMES.111.000058
- Link to fulltext article
- Abstract
- Background—Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. Methods and Results—This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to >60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. Conclusions—Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.
- Author for correspondence
- Nathaniel M. Hawkins
- Email for correspondence
- nathawkins@hotmail.com
Code list: res15: Myocardial Infarction
86 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 14A3.00 | Read | H/O: myocardial infarct <60 | diagnostic | res15: Myocardial Infarction | |||
| 14A4.00 | Read | H/O: myocardial infarct >60 | diagnostic | res15: Myocardial Infarction | |||
| 14AH.00 | Read | H/O: MI in last year | diagnostic | res15: Myocardial Infarction | |||
| G30..00 | Read | Acute MI | diagnostic | res15: Myocardial Infarction | |||
| G300.00 | Read | Acute anterolateral infarction | diagnostic | res15: Myocardial Infarction | |||
| G301.00 | Read | Other specified anterior MI | diagnostic | res15: Myocardial Infarction | |||
| G301000 | Read | Acute anteroapical infarction | diagnostic | res15: Myocardial Infarction | |||
| G30..11 | Read | Attack - heart | diagnostic | res15: Myocardial Infarction | |||
| G301100 | Read | Acute anteroseptal infarction | diagnostic | res15: Myocardial Infarction | |||
| G30..12 | Read | Coronary thrombosis | diagnostic | res15: Myocardial Infarction | |||
| G30..13 | Read | Cardiac rupture following MI | diagnostic | res15: Myocardial Infarction | |||
| G30..14 | Read | Heart attack | diagnostic | res15: Myocardial Infarction | |||
| G30..15 | Read | MI - acute MI | diagnostic | res15: Myocardial Infarction | |||
| G30..16 | Read | Thrombosis - coronary | diagnostic | res15: Myocardial Infarction | |||
| G30..17 | Read | Silent MI | diagnostic | res15: Myocardial Infarction | |||
| G301z00 | Read | Anterior MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G302.00 | Read | Acute inferolateral infarction | diagnostic | res15: Myocardial Infarction | |||
| G303.00 | Read | Acute inferoposterior infarction | diagnostic | res15: Myocardial Infarction | |||
| G304.00 | Read | Posterior MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G305.00 | Read | Lateral MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G306.00 | Read | True posterior MI | diagnostic | res15: Myocardial Infarction | |||
| G307.00 | Read | Acute subendocardial infarction | diagnostic | res15: Myocardial Infarction | |||
| G307000 | Read | Acute non-Q wave infarction | diagnostic | res15: Myocardial Infarction | |||
| G307100 | Read | Acute non-ST segment elevation MI | diagnostic | res15: Myocardial Infarction | |||
| G308.00 | Read | Inferior MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G309.00 | Read | Acute Q-wave infarct | diagnostic | res15: Myocardial Infarction | |||
| G30B.00 | Read | Acute posterolateral MI | diagnostic | res15: Myocardial Infarction | |||
| G30X.00 | Read | Acute transmural MI of unspecif site | diagnostic | res15: Myocardial Infarction | |||
| G30X000 | Read | Acute ST segment elevation MI | diagnostic | res15: Myocardial Infarction | |||
| G30y.00 | Read | Other acute MI | diagnostic | res15: Myocardial Infarction | |||
| G30y000 | Read | Acute atrial infarction | diagnostic | res15: Myocardial Infarction | |||
| G30y100 | Read | Acute papillary muscle infarction | diagnostic | res15: Myocardial Infarction | |||
| G30y200 | Read | Acute septal infarction | diagnostic | res15: Myocardial Infarction | |||
| G30yz00 | Read | Other acute MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G30z.00 | Read | Acute MI NOS | diagnostic | res15: Myocardial Infarction | |||
| G310.00 | Read | PostMI syndrome | diagnostic | res15: Myocardial Infarction | |||
| G32..00 | Read | Old MI | diagnostic | res15: Myocardial Infarction | |||
| G32..11 | Read | Healed MI | diagnostic | res15: Myocardial Infarction | |||
| G33z500 | Read | Post infarct angina | diagnostic | res15: Myocardial Infarction | |||
| G35..00 | Read | Subsequent MI | diagnostic | res15: Myocardial Infarction | |||
| G350.00 | Read | Subsequent MI of anterior wall | diagnostic | res15: Myocardial Infarction | |||
| G351.00 | Read | Subsequent MI of inferior wall | diagnostic | res15: Myocardial Infarction | |||
| G353.00 | Read | Subsequent MI of other sites | diagnostic | res15: Myocardial Infarction | |||
| G35X.00 | Read | Subsequent MI of unspecified site | diagnostic | res15: Myocardial Infarction | |||
| G36..00 | Read | Certain current complication follow acute myocardial infarct | diagnostic | res15: Myocardial Infarction | |||
| G360.00 | Read | Haemopericardium/current comp folow acut myocard infarct | diagnostic | res15: Myocardial Infarction | |||
| G361.00 | Read | Atrial septal defect/curr comp folow acut myocardal infarct | diagnostic | res15: Myocardial Infarction | |||
| G362.00 | Read | Ventric septal defect/curr comp fol acut myocardal infarctn | diagnostic | res15: Myocardial Infarction | |||
| G363.00 | Read | Ruptur cardiac wall w'out haemopericard/cur comp fol ac MI | diagnostic | res15: Myocardial Infarction | |||
| G364.00 | Read | Ruptur chordae tendinae/curr comp fol acute myocard infarct | diagnostic | res15: Myocardial Infarction | |||
| G365.00 | Read | Rupture papillary muscle/curr comp fol acute myocard infarct | diagnostic | res15: Myocardial Infarction | |||
| G366.00 | Read | Thrombosis atrium,auric append&vent/curr comp foll acute MI | diagnostic | res15: Myocardial Infarction | |||
| G37..00 | Read | Cardiac syndrome X | diagnostic | res15: Myocardial Infarction | |||
| G38..00 | Read | Postoperative MI | diagnostic | res15: Myocardial Infarction | |||
| G380.00 | Read | Postoperative transmural MI anterior wall | diagnostic | res15: Myocardial Infarction | |||
| G381.00 | Read | Postoperative transmural MI inferior wall | diagnostic | res15: Myocardial Infarction | |||
| G382.00 | Read | Postoperative transmural MI other sites | diagnostic | res15: Myocardial Infarction | |||
| G383.00 | Read | Postoperative transmural MI unspec site | diagnostic | res15: Myocardial Infarction | |||
| G384.00 | Read | Postoperative subendocardial MI | diagnostic | res15: Myocardial Infarction | |||
| G38z.00 | Read | Postoperative MI, unspecified | diagnostic | res15: Myocardial Infarction | |||
| G501.00 | Read | Post infarction pericarditis | diagnostic | res15: Myocardial Infarction | |||
| Gyu3100 | Read | [X]Other current complications following acute myocard infarct | diagnostic | res15: Myocardial Infarction | |||
| Gyu3400 | Read | [X]Acute transmural MI of unspecif site | diagnostic | res15: Myocardial Infarction | |||
| Gyu3500 | Read | [X]Subsequent MI of other sites | diagnostic | res15: Myocardial Infarction | |||
| Gyu3600 | Read | [X]Subsequent MI of unspecified site | diagnostic | res15: Myocardial Infarction | |||
| 4100N | OXMIS | MI with hypertension | diagnostic | res15: Myocardial Infarction | |||
| 4100NA | OXMIS | MI acute with hypertension | diagnostic | res15: Myocardial Infarction | |||
| 4100T | OXMIS | Thrombosis coronary with hypertension | diagnostic | res15: Myocardial Infarction | |||
| 4109CA | OXMIS | Attack coronary | diagnostic | res15: Myocardial Infarction | |||
| 4109CL | OXMIS | Occlusion coronary | diagnostic | res15: Myocardial Infarction | |||
| 4109CR | OXMIS | Accident coronary | diagnostic | res15: Myocardial Infarction | |||
| 4109H | OXMIS | Myocardial infarct old | diagnostic | res15: Myocardial Infarction | |||
| 4109HE | OXMIS | Myocardial infarct healed | diagnostic | res15: Myocardial Infarction | |||
| 4109N | OXMIS | Myocardial infarct | diagnostic | res15: Myocardial Infarction | |||
| 4109NA | OXMIS | Myocardial infarct acute | diagnostic | res15: Myocardial Infarction | |||
| 4109NC | OXMIS | Coronary infarction | diagnostic | res15: Myocardial Infarction | |||
| 4109NH | OXMIS | Infarct heart | diagnostic | res15: Myocardial Infarction | |||
| 4109TC | OXMIS | Thrombosis coronary | diagnostic | res15: Myocardial Infarction | |||
| 4109TE | OXMIS | Thrombosis endocardial | diagnostic | res15: Myocardial Infarction | |||
| 4109TL | OXMIS | Thrombosis mural | diagnostic | res15: Myocardial Infarction | |||
| 4109TM | OXMIS | Myocardial thrombosis | diagnostic | res15: Myocardial Infarction | |||
| 4119N | OXMIS | Subendocardial infarction | diagnostic | res15: Myocardial Infarction | |||
| 4129B | OXMIS | Syndrome post MI | diagnostic | res15: Myocardial Infarction | |||
| 4129T | OXMIS | Status post MI | diagnostic | res15: Myocardial Infarction | |||
| 4129TH | OXMIS | Coronary infarction healed | diagnostic | res15: Myocardial Infarction | |||
| 429 AH | OXMIS | Heart attack | diagnostic | res15: Myocardial Infarction |
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