Age related policy in cardiology: comparison of health care provision in UK and Italy.

Background. There is evidence that several procedures are frequently provided only in relation to age, older people with coronary heart disease are often not considered for intervention by general practitioners and there is a not favourable tendency in using diagnostic techniques in that age. Aim. To investigate the influence of age of patient on the appropriate clinical management of cardiovascular diseases in UK and Italy. Methods. Retrospective analysis of patients’ medical case notes (1790 in UK and 2576 in Italy) in cardiology, internal medicine and elderly clinics during the period 1996–1997, considering: exercise tolerance test (ETC), coronary angiography (CA) and coronary artery bypass grafting (CABG). Results. Older patients and women, independently, were less likely to undergo ETC, particularly for people older than 75 in Italy (OR =0.161), and for women in UK (OR = 0.61). Similar trends for age and access to CA achieved significance, with older people in Italy less likely to undergo this procedure (OR =0.062). Differences by sex were found only in UK (OR = 0.187 for women). In Italy clinical conditions were independent influent factors for having CA (OR = 0.482 for patients with poor Parsonnet score). Trends for age and sex did not achieve significance for CAGB (OR= 0.815 for older patient in Italy; OR = 0.515 for British women). In Italy clinical conditions were influent factors for having CAGB (OR= 42.032 for patients with very high Parsonnet score). Conclusions. Clinical management of older patients with cardiac disease in both nations, and of women in UK, may be different from that of younger patients, and of men in UK. One possible explanation would be that these patients are being discriminated against principally because of their age and sex.