Skip to main content Accessibility help

The Appropriateness of the Use of Cardiovascular Procedures: British Versus U.S. Perspectives

  • Steven J. Bernstein (a1), Jacqueline Kosecoff (a2), David Gray (a2), John R. Hampton (a3) and Robert H. Brook (a4)...


To determine whether patients are less likely to receive an inappropriate procedure in countries that devote fewer resources to health care than does the United States, we studied how appropriately coronary angiography and coronary artery bypass surgery were performed in the Trent region of the United Kingdom. The medical records of 320 patients who underwent coronary angiography and 319 who underwent coronary artery bypass surgery in 1987 and 1988 were randomly selected for review. Despite the United Kingdom's more limited use of coronary angiography and coronary artery bypass surgery, a substantial proportion were still performed for less than appropriate reasons, by both U.S. and U.K. criteria. Merely reducing the rate of use of these procedures will not be sufficient to eliminate such inappropriate use.



Hide All
1.Bainton, D., Baker, I. A., Sweetnam, P. M, et al. Prevalence of ischemic heart disease: The Caerphilly and Speedwell surveys. British Heart Journal, 1988, 59, 201–06.
2.Berman, D. M., Brook, R. H., Lohr, K. N., et al. Conceptualization and measurement of physiologic health for adults: Angina pectoris. Santa Monica, CA: The RAND Corporation, R-2262/4-HHS, 1981.
3.Brook, R. H., Chassin, M. R., Fink, A., et al. A method for the detailed assessment of the appropriateness of medical technologies. International Journal of Technology Assessment in Health Care, 1986, 2, 5363.
4.Brook, R. H., Kosecoff, J., Park, R. E., et al. Diagnosis and treatment of coronary disease: Comparison of doctors’ attitudes in the USA and the UK. Lancet, 1988, i, 750–53.
5.Brook, R. H., & Lohr, K. N.Efficacy, effectiveness, variations, and quality: Boundary-crossing research. Medical Care, 1985, 23, 710–22.
6.Califano, J. A. Jr., The health-care chaos. The New York Times, 03 20,1988, Sec. 6, p. 44.
7.Campeau, L.Grading of angina pectoris. Circulation, 1976, 54, 522–23.
8.Chassin, M. R., Brook, R. H., Park, R. E., et al. Variations in the use of medical and surgical services by the Medicare population. New England Journal of Medicine, 1986, 314, 285–90.
9.Chassin, M. R., Kosecoff, J., Park, R. E., et al. Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures. Journal of the American Medical Association, 1987, 258, 2533–37.
10.Ellwood, P. M.Outcomes management: A technology of patient experience. New England Journal of Medicine, 1988, 318, 1549–56.
11.Fink, A., Kosecoff, J., Chassin, M., & Brook, R. H.Consensus methods: Characteristics and guidelines for use. American Journal of Public Health, 1984, 74, 979–83.
12. Gray, D. Personal communication.
13.Gray, D., Hampton, J. R., Bernstein, S. J., et al. An audit of coronary angiography and coronary artery bypass surgery in the Trent region based on ratings of appropriateness. Lancet, 1990, 335, 1317–20.
14.Kramer, M. S., & Feinstein, A. R.Clinical biostatistics: The biostatistics of concordance. Clinical Pharmacology and Therapeutics, 1981, 29, 111–23.
15.Leape, L. L., Park, R. E., Solomon, D. H., et al. Does inappropriate use explain small-area variations in the use of health care services? Journal of the American Medical Association, 1990, 263, 669–72.
16.McPherson, K., Wennberg, J. E., Hovind, O. B., & Clifford, P.Small-area variations in the use of common surgical procedures: An international comparison of New England, England, and Norway. New England Journal of Medicine, 1982, 307, 1310–14.
17.National Center for Health Statistics. National hospital discharge survey: Annual summary, United States, 1987. Vital and health statistics. Series 13. No. 99. Washington, DC: Government Printing Office, 1989 (DHHS Publication no. [PHS] 89–1760).
18.Park, R. E., Fink, A., Brook, R..H., et al. Physician ratings of appropriate indications for six medical and surgical procedures. American Journal of Public Health, 1986, 76, 766–72.
19.Regional Office for Europe, World Health Organization. Monitoring of the strategy for health for all by the year 2000. Thirty-eighth session, Copenhagen, 09 12–17, 1988 (Working paper).
20.Rose, G., Reid, D. D., Hamilton, P. J. S., et al. Myocardial ischaemia, factors and death from coronary heart disease. Lancet, 1977, i, 105–09.
21.Uemura, K., & Pisa, Z.Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Statistics Quarterly, 1988, 41, 155–76.
22.Vayda, E., Mindell, W. R., & Rutlow, I. M.A decade of surgery in Canada, England and Wales, and the United States. Archives of Surgery, 1982, 117, 846–53.
23.Winslow, C. M., Kosecoff, J., Chassin, M. R., et al. The appropriateness of performing coronary artery bypass surgery. JAMA, 1988, 260, 505–09.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed