Is it feasible to plan secondary care services for coronary heart disease rationally? A quantified modelling approach for a UK Health Authority

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Abstract
BACKGROUND Coronary heart disease (CHD) is the major cause of mortality in the UK. This paper explores the difficulties facing health authorities in applying a rational and needs based approach to the planning of hospital based services and describes a simple model used to bring available information to bear on this problem. METHOD Published estimates of CHD incidence were identified and methodologies were critically appraised. Estimates were extrapolated to a district population. A three month cohort study of patients with suspected CHD was undertaken within a district general hospital and a model of these clinical pathways was used to examine the volumes of patients and services required to meet the estimated levels of need. RESULTS From published studies, estimates of CHD incidence ranged from 83 to 3600 per 100 000. From the cohort study, of patients referred with possible CHD 62% received a definitive diagnosis of CHD, 56% underwent an exercise ECG, 16% received an angiogram, 4% received a CABG and 2% a PTCA. Using these figures together with the cohort study, estimated activity ranges from 247 to 6475 surgical interventions per million population compared with the National Service Framework for Coronary Heart Disease recommendations of 1500 procedures per million. CONCLUSIONS Current research on CHD incidence gives a very wide variation in estimated need. This makes its value for service planning questionable and the model highlights a need for further high quality research. The model provides a link between epidemiological research and secondary care service planning and supports the implementation of recommendations within the National Service Framework for Coronary Heart Disease.