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Age, Race, and Gender Variation in the Utilization of Coronary Artery Bypass Surgery and Angioplasty in SHEP
Author(s) -
Bearden Donna,
Allman Richard,
McDonald Robert,
Miller Stephen,
Presse Sara,
Petrovitch Helen
Publication year - 1994
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1994.tb06979.x
Subject(s) - medicine , cohort , angioplasty , population , ambulatory , coronary artery disease , coronary artery bypass surgery , cardiology , prospective cohort study , marital status , artery , surgery , environmental health
OBJECTIVE : To assess variability in the use of coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) in the Systolic Hypertension in the Elderly Program (SHEP) cohort with incident coronary heart disease (CHD) by age, sex, and race. DESIGN : Retrospective analysis of a multicenter prospective cohort study. PATIENTS : Among 4736 subjects initially enrolled in SHEP, there were 432 incident cases of CHD, excluding those patients who experienced rapid or sudden cardiac death. SETTING : Community‐based ambulatory population in academic centers. MAIN OUTCOME MEASURE : Incident cases of CHD who underwent CABG or PTCA. RESULTS : Of those participants ≤ 60 and <75 years of age, 7.3% underwent PTCA, compared with 3.9% of those >75 years (P = 0.14). 15.4% of those lt75 underwent CABG surgery, compared with 7.8% of those 75 and older (P = 0.018). When both of these endpoints, CABG and PTCA, were combined, 22.4% of those lt75 underwent a procedure, while only 11.7% of the older cohort did (P = 0.005). Twenty‐six percent of men underwent either CABG or PTCA, while only 9.1% of women did (P < 0.001). Of those <75 years of age, 31.1% of men and 12.3% of women underwent CABG or PTCA (P < 0.001). In the 75 and older age category, 19.5% of men underwent these interventions, compared with 5.9% of women (P = 0.005). Active treatment group was significantly associated with decreased use of procedures in participants <75 year old with CHD. Race, activity limitations, number of comorbid conditions, education level, marital status, employment status, and social support were not significantly associated with CABG or PTCA use. When the variables studied were ntered into a logistic regression model, increased age and female sex remained independently associated with decreased CABG and PTCA use. CONCLUSION : In the SHEP trial older patients and women, regardless of comorbid conditions, socioeconomic status, and social support, underwent less intensive cardiovascular interventions than did younger patients and men when they developed CHD.