Under Use of Coronary Angiography

It is important to develop standards of quality to address and safeguard against underuse of necessary medical care. This article looks at the underuse of coronary angiography in four teaching hospitals in Los Angeles. The study involved 350 patients who had had a positive exercise stress test and relates those results to explicitly defined criteria for the necessity of coronary angiography, which were established by a multidisciplinary expert panel. The main result of the study is that just 43% of these patients received necessary coronary angiography within 3 months of the stress test, and 56% received such necessary coronary angiography within 12 months. Women were less likely than men to receive necessary coronary angiography, as were public-hospital patients. The major conclusion of this study is that underuse of coronary angiography can be measured and occurs to a significant degree.