To the Editors:
We were very interested in the paper by Toshner et al. 1 which highlights regional variations in pulmonary endarterectomy (PEA) rates for the UK population. The authors explore the reasons for this variability. Understandably they dismiss the possibility of differences due to variability in incidence or management. Their analysis looks at the PEA rate rather than the referral rate. This reduces, but does not abolish, the varying threshold for referral by designated centres as a cause. However, they conclude that the differences shown in the paper, are in a large part, due to the distance of patients from nationally designated centres for the management of pulmonary hypertension.
The one region that does not fit with this explanation is Scotland (UK) where there is a national centre for the management of pulmonary hypertension (the Scottish Pulmonary …