Delay to invasive investigation and revascularisation for coronary heart disease in south west Thames region: a two tier system?

OBJECTIVES--To assess the accessibility of invasive investigation and revascularisation procedures in the management of coronary heart disease in a defined population in the South West Thames region over 10 years, and to audit the performance of both the NHS and the private sector. DESIGN--Analysis of all patient referrals to the regional cardiothoracic centres for coronary heart disease during 1979-88. SETTING--North West Surrey District Health Authority, which had a mean catchment population of 205,000 during the study period. The health district is one of the 13 in the South West Thames region. PATIENTS--823 patients aged 34-80 years with suspected coronary heart disease, 204 of whom were referred for private investigation and 619 were referred within the NHS. The NHS referrals were mainly to St Thomas9s Hospital during 1979-83 and to St George9s Hospital during 1984-8. MAIN OUTCOME MEASURES--Difference in time to investigation and intervention between the NHS and the private patients. RESULTS--After some variation in earlier years the mean (SD, range) waiting times from referral to cardiac catheterisation and then revascularisation increased progressively in NHS patients, to 115.8 (126.5, 22-482) days and 305.9 (164.4, 22-620) days respectively in 1988. There was no significant change over the 10 years in waiting times within the private sector, with a mean of 17.2 (18.2, 1-62) days to angiography and 22.8 (14.5, 2-152) days to surgery. Fifteen people on the NHS waiting list died of probable cardiac causes. No people on the private waiting list died. CONCLUSIONS--The performance of the NHS system in South West Thames region in response to emergency referral is adequate. The waiting time to routine investigation and revascularisation is prolonged and seems to be worsening despite increased investigative and surgical activity by the regional centre. The delays may subject NHS patients to unnecessary risk, which is not shared by private patients.