Is cardiac catheterization being appropriately utilized in Trinidad and Tobago?

ABSTRACT

Coronary angiography is an expensive technology which has recently become available in Trinidad and Tobago. Established methods have not so far been proposed to monitor the appropriateness of its utilization. We hypothesized that a frequency of normal results comprising greater than 25 percent of the population undergoing coronary angiography should prompt a review of policy with a view to improving resource utilization. This is consistent with the American Heart Association's benchmark figure of 25 percent set for mature laboratories operating in the United States. We therefore retrospectively reviewed all catheterization records of patients undergoing cardiac catheterization at the Eric Williams Medical Sciences Complex during its first three years of operation (1993-1995). Of a total of 785 patients undergoing procedures, 453 had coronary angiography. The number of studies per year increased from 96 in 1993, to 190 in 1994 and 167 in 1995. Thirty-one percent of patients were reported to have normal coronary arteries in the first year of operation. However, this fell to 22 per cent in 1994 and 21 percent in 1995. The first year's statistics are believed to represent a cautious initial referring practice and a learning curve. Second and third year statistics confirm an appropriate pattern of cost-efficient utilization of cardiac catheterization resources at this institution. We propose that the frequency of the finding of normal coronary angiograms is a valid indicator of the appropriateness of resource utilization, which should be voluntarily reported by catheterization laboratories throughout the region (AU)