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Cardiology services after stress testing: are there sex differences? A population-based study
S C Daly1, V L Roger, C Leibson
1Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Insights
Women with no coronary artery disease (CAD) and those with positive stress tests were less likely to receive preventive cardiology visits. No sex differences were found in overall cardiology visits post-stress test.
Area of Science:
- Cardiology
- Health Services Research
- Epidemiology
Background:
- Sex differences in invasive cardiac procedures are known, but data on physician encounters are limited.
- Understanding physician visit patterns is crucial for equitable cardiovascular care.
- Previous research highlights disparities in cardiac care for women.
Purpose of the Study:
- To investigate sex differences in cardiology visit utilization after stress testing.
- To determine if female sex is associated with fewer cardiology visits, especially in patients without coronary artery disease (CAD).
- To examine sex-based differences in preventive cardiology visits.
Main Methods:
- A population-based cohort study of Olmsted County residents undergoing stress tests between 1987-1989.
- Medical record review for baseline characteristics, CAD diagnosis, and cardiology visits within one year post-stress test.
- Regression models to assess the independent association of female sex with cardiology visit probability.
Main Results:
- No significant sex differences in inpatient or outpatient/consultative cardiology visits were observed.
- Women were significantly less likely to receive preventive cardiology visits (OR 0.77, P=0.02).
- This disparity was pronounced in older women with CAD and in women with positive stress tests but no documented CAD.
Conclusions:
- While overall cardiology visit rates were similar between sexes, women received fewer preventive cardiology visits post-stress test.
- Further research is needed to elucidate the reasons for and clinical implications of these sex-based differences in preventive care utilization.
- Addressing these disparities is essential for improving cardiovascular health outcomes for women.
Abstract:
To test the hypothesis that, in a population-based cohort of persons undergoing stress tests, female sex was negatively associated with the use of cardiology visits in persons with no documented coronary artery disease (CAD) but that this association did not exist when CAD was established. Sex differences in the use of invasive cardiac procedures have been clearly documented, but data on physician encounters, an integral part of care, are lacking. A population-based cohort consisting of all Olmsted County, Minnesota residents who underwent an initial stress test in 1987, 1988, and 1989 in Olmsted County was examined. Medical records were reviewed for baseline characteristics including CAD diagnosis status, test results, and cardiology visits in the year following the stress test. Regression models were constructed to determine whether sex is independently associated with the probability of a visit. In the year after stress testing, there was no difference between the sexes in the use of inpatient (OR for female sex 0.88, 95% CI 0.62-0.97, P = 0.365) and outpatient/consultative (OR for female sex 1.24, 95% CI 0.95-1.61, P = 0.6) cardiology visits. Women were, however, less likely to receive preventive cardiology visits (OR for female sex 0.77, 95% CI 0.62-0.97, P = 0.02). This was largely related to less use of preventive visits among older women with documented coronary artery disease (CAD). In the absence of documented CAD, when the stress test was positive, women were less likely to receive preventive visits. In this geographically defined population within one year after an initial stress test, there was no sex difference in the use of in-patient or out-patient visits but women were less likely to receive preventive cardiology visits in the year after stress testing. Further studies are needed to understand the reasons for and impact of these care patterns.