Sex bias in considering coronary bypass surgery

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.