Gender differences in the management and outcome of patients with acute coronary artery disease
R A Raine1, N A Black, T J Bowker
1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. rosalind.raine@lshtm.ac.uk
Insights
This study found no gender differences in cardiac investigations or revascularization for acute coronary syndromes. However, men with hypertension were more likely to receive cardiac rehabilitation than women.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Existing literature suggests a gender bias in coronary heart disease management favoring men.
- Understanding gender disparities in acute coronary syndrome (ACS) care is crucial for equitable healthcare.
- Sociodemographic and clinical factors may influence treatment and outcomes in ACS patients.
Purpose of the Study:
- To compare clinical management and health outcomes between men and women after acute coronary syndrome admission.
- To adjust for disease severity, sociodemographic factors, and cardiac risk factors in the comparison.
- To investigate potential gender-based differences in cardiac care pathways and interventions.
Main Methods:
- Prospective national survey of acute cardiac admissions in the UK.
- Follow-up via mailed patient questionnaires 2-3 years post-admission.
- Inclusion of 1064 patients under 70 years old from 94 district general hospitals.
Main Results:
- No significant gender differences were observed in the utilization of cardiac investigations or overall revascularization procedures.
- Male patients with hypertension showed a higher likelihood of undergoing cardiac rehabilitation compared to hypertensive females.
- Men were more likely to undergo coronary artery bypass grafting (CABG), but overall revascularization rates did not differ by gender.
Conclusions:
- This national survey did not find evidence of gender bias in cardiac investigations or overall revascularization for acute coronary syndromes.
- Further investigation is needed into the selection criteria for percutaneous transluminal coronary angioplasty versus CABG and the use of cardiac rehabilitation.
- The study highlights the need to ensure clinical decisions for interventions are based solely on medical necessity.
Study Objective:
s: To compare the clinical management and health outcomes of men and women after admission with acute coronary syndromes, after adjusting for disease severity, sociodemographic, and cardiac risk factors.
Design:
Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission.
Setting:
Random sample of 94 district general hospitals in the UK.
Patients:
1064 patients under 70 years old recruited between April 1995 and November 1996.
Main Results:
Of the 1064 patients recruited, 126 (11.8%) died before follow up. Of the 938 survivors, 719 (76.7%) completed a follow up questionnaire. There were no gender differences in the use of cardiac investigations during the index admission or follow up period. However, male patients with hypertension were more likely to undergo rehabilitation compared with female hypertensive patients (OR 2.01, 95% CI 0.85 to 4.72). Men were also more likely to undergo coronary artery bypass grafting (CABG) than women (OR 1.90, 95%CI 1.21 to 3.00), but there was no gender difference in the use of revascularisation overall (p=0.14). An indirect indication that the gender differences in CABG were not attributable to bias was provided by the lack of gender differences in health outcomes, which implies that patients received the care they needed.
Conclusions:
Despite the extensive international literature referring to a gender bias in favour of men with coronary heart disease, this national survey found no gender differences in the use of investigations or in revascularisation overall. However, the criteria used for selecting percutaneous transluminal coronary angioplasty compared with CABG requires further investigation as does the use of rehabilitation. It is unclear whether the clinical decisions to provide these procedures are made solely on the basis of clinical need.
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