Sex and Cardiac Operations: Are We Being Fair to Our Female Patients?

Research suggests that although men have a higher cardiovascular disease (CVD) rate, women with CVD are more likely to experience a poorer prognosis, possibly owing to incorrect diagnosis and poorer treatment. A question not yet addressed is whether some of this inequality could be due to sex bias when selecting patients for operation.

The participants were from the Scottish Heart Health Extended Cohort who had been admitted to hospital with a cardiovascular diagnosis over the study period. Participants were recruited between 1984 and 1995 and followed up until 2017. Using propensity score nearest neighbour matching, women were matched 1:1 with men on year of birth, year and reason of admission, smoking status, previous cardiovascular disease (CVD), and family history of CVD. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals.

After matching, 19,960 admissions (50% women) to hospital for cardiac reasons were available for analysis. Women were less likely to have a cardiac intervention, that is (endovascular or surgical revascularisation), after admission for any cardiovascular reason (6.83% of men, 2.84% of women; odds ratio [OR] 0.56; 95% confidence intervals [CIs] 0.42-0.75), or admission for cardiac ischaemia only (11.07% of men; 6.09% of women; OR 0.52; 95% CI 0.37-0.74). The sex difference was more pronounced in the early part of the study but persisted in the latter phase.

In this matched study of cardiovascular admissions to Scottish hospitals, women were less likely to be recommended for a surgical procedure, even when matched with men for common CVD risk factors.