Gender disparity and the appropriateness of myocardial perfusion imaging

Appropriate use criteria (AUC) were developed to guide the use of myocardial perfusion imaging (MPI). While MPI use has grown exponentially, women remain under tested. Given this bias in testing, we sought to determine if gender disparity exists in tests categorized by appropriateness and the role of referral bias.

The AUC were applied to 314 consecutive MPI. Analysis of variance and chi-squared tests were used for analysis. Gender disparity was assessed using correlation matrices comparing baseline to gender reversed data.

Of the 314 studies, 263 were appropriate, 34 inappropriate, and 17 uncertain. Women had 68% of inappropriate studies, and 82% of uncertain studies (P < .01). Cardiologists ordered more appropriate studies than primary care physicians (PCPs) in women (86% vs 71%, P = .04). Among studies ordered by cardiologists and PCPs, a higher percentage of studies were appropriate in men vs women (96% vs 86%, P = 0.05 and 88% vs 71% P = .003), respectively. Gender reversal demonstrates disparity in the AUC tool with 46 (15%) not correlating (P < .00001).

Comparing patient gender and ordering physician, the majority of inappropriate and uncertain studies were ordered in women by PCPs, indicating a continuing need for education among PCPs, particularly as the AUC apply to women.