Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jan 18, 2019; 9(1): 1-19
Published online Jan 18, 2019. doi: 10.5662/wjm.v9.i1.1
Risk stratification for coronary artery disease in multi-ethnic populations: Are there broader considerations for cost efficiency?
Pupalan Iyngkaran, William Chan, Danny Liew, Jalal Zamani, John D Horowitz, Michael Jelinek, David L Hare, James A Shaw
Pupalan Iyngkaran, Department of Cardiology, Flinders University, NT Medical School, Darwin 0810, Australia
William Chan, Department of Cardiology Alfred and Western Health, University of Melbourne, Victoria 3004, Australia
Danny Liew, Clinical Outcomes Research, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia
Jalal Zamani, Department of Interventional Cardiology, Feris Shiraz University, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
John D Horowitz, Department of Cardiology and Clinical Pharmacology, the Queen Elizabeth Hospital, University of Adelaide, Adelaide 5011, Australia
Michael Jelinek, Department of Cardiology, Vincent’s Hospital, Melbourne, Victoria 3065, Australia
David L Hare, Cardiovascular Research, University of Melbourne, Melbourne, Victoria 3084, Australia
James A Shaw, Department of Cardiology, The Alfred Hospital, Baker IDI Heart and Diabetes Institute, Melbourne, Vic 3004, Australia
Author contributions: Iyngkaran P and Jelinek M contributed equally to this work; Iyngkaran P, Jelinek M, Horowitz J, Chan W, Zamanji J, Hare DL, Shaw J designed research paper; Iyngkaran P performed literature review, support from Jelinek M; Iyngkaran P wrote the paper; all authors analyzed data and provided feedback.
Conflict-of-interest statement: All co-authors have won independent and governmental research funding. None pose a conflict of interest for this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Pupalan Iyngkaran, FRACP, MBBS, Doctor, Department of Cardiology, Flinders University, NT Medical School, Darwin 0810, Australia. balaniyngkaran@hotmail.com
Telephone: +61-03-97487377 Fax: +61-03-97487377
Received: June 6, 2018
Peer-review started: June 6, 2018
First decision: June 6, 2018
Revised: August 15, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: January 18, 2019
Processing time: 63 Days and 1.6 Hours
Abstract

Coronary artery disease (CAD) screening and diagnosis are core cardiac specialty services. From symptoms, autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies. While angina remains a clinical diagnosis, most cases require correlation with a diagnostic modality. At the onset of the evidence building process much research, now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available. Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived. While it would seem very unlikely that for the majority, scientific arguments against guidelines would differ, however from a translational perspective, there will be populations who differ and importantly there are cost-efficacy questions, e.g., the most suitable first-line tests or what parameters equate to an adequate test. This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.

Keywords: Cost efficacy; Coronary artery disease; Coronary heart disease; Ethnicity; Outcomes; Risk stratification

Core tip: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Globalisation has seen an epidemiological shift in demographics and risk for populations. In planning a cost-effective health service it is important to understand demographic risk and variables in interpretating and managing CAD.