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Sex bias in considering coronary bypass surgery
Annals of Internal Medicine
|July 1, 1987
Summary
Physicians referred men for cardiac catheterization 10 times more often than women, despite similar abnormal nuclear stress test results. This suggests coronary artery bypass surgery may be underused in women.
Area of Science:
- Cardiovascular Medicine
- Nuclear Cardiology
- Medical Decision Making
Background:
- Cardiovascular nuclear medicine exercise studies are used to guide decisions on cardiac catheterization and coronary artery bypass surgery.
- Previous research indicates potential sex-based disparities in healthcare, but specific referral patterns for cardiovascular interventions require further investigation.
Purpose of the Study:
- To investigate sex differences in physician referral decisions for cardiac catheterization following abnormal nuclear exercise tests.
- To determine if observed referral disparities are explained by test sensitivity, coronary artery disease prevalence, or surgical benefits.
Main Methods:
- Analysis of data from 390 patients referred for nuclear exercise testing.
- Comparison of referral rates for cardiac catheterization between men and women with abnormal test results.
- Logistic regression analysis controlling for age, prior myocardial infarction, angina type, and test abnormalities.
Main Results:
- Abnormal nuclear exercise test results were found in 31% of women and 64% of men.
- Physicians referred 4% of women with abnormal scans versus 40% of men for catheterization (a 10:1 ratio).
- This referral disparity persisted after controlling for clinical factors, with an odds ratio of 6.3 for men.
Conclusions:
- Sex-based differences in referral for cardiac catheterization cannot be solely attributed to test performance or disease prevalence.
- The findings suggest a potential underutilization of coronary artery bypass surgery in women.
- Further research is warranted to explore the reasons behind these sex differentials in referral patterns.
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