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Gender differences in clinical evaluation and triage in coronary artery disease
1Department of Medicine, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago.
Insights
Women with coronary heart disease receive less invasive cardiac evaluation and treatment than men. This study found a gender bias in procedures like coronary arteriography and bypass surgery, impacting women
Area of Science:
- Cardiology
- Medical Ethics
- Health Disparities
Background:
- Women are evaluated and treated for cardiac diseases less often than men with similar symptoms.
- Existing disparities in cardiac care for women warrant investigation into potential gender bias.
- Coronary heart disease (CHD) affects women, necessitating equitable diagnostic and therapeutic approaches.
Purpose of the Study:
- To identify gender-based differences in the clinical evaluation and treatment of patients with coronary heart disease.
- To investigate whether gender bias influences the diagnostic and interventional procedures offered to men and women with CHD.
- To analyze demographic, clinical, and angiographic parameters by gender in patients with cardiac ischemic syndrome.
Main Methods:
- Retrospective review of patients admitted with cardiac ischemic syndrome at a single university hospital over one year.
- Analysis of gender-specific data for patients undergoing stress testing, coronary arteriography, or revascularization.
- Evaluation of demographic, clinical, and angiographic parameters stratified by gender.
Main Results:
- Women with a coronary diagnosis were less likely to undergo coronary arteriography compared to men.
- Women with positive stress test results had similar rates of coronary arteriography as men.
- While women undergoing arteriography were equally likely to have percutaneous transluminal coronary angioplasty, they were less likely to undergo coronary artery bypass surgery.
Conclusions:
- A significant gender-based selection bias exists in the utilization of coronary arteriography.
- Bias in treatment recommendations was observed, particularly for coronary artery bypass grafting in women.
- Addressing gender disparities in cardiac care is crucial for equitable treatment of coronary heart disease.
Background:
Women undergo evaluation and treatment for cardiac diseases less frequently than men with similar symptoms. The purpose of this study was to determine what differences exist in clinical evaluation and treatment between men and women presenting with coronary heart disease that may indicate a gender bias.
Methods:
A single hospital retrospective review of patients admitted with the diagnosis of cardiac ischemic syndrome, undergoing stress testing, coronary arteriography, percutaneous interventional procedure, or coronary bypass surgery was performed, including an evaluation by gender of the demographic, clinical, and angiographic parameters of 1 year of patients undergoing hospital admission, evaluation, or revascularization therapy for coronary heart disease in a single university hospital.
Results:
Women admitted to the coronary care unit with a coronary diagnosis were less likely to undergo coronary arteriography than men. Women having a positive stress test result were as likely to undergo coronary arteriography as men with similar findings. Women undergoing coronary arteriography were as likely as men to undergo percutaneous transluminal coronary angioplasty, but less likely to undergo coronary artery bypass surgery.
Conclusions:
A gender-based selection bias exists in choosing patients to undergo coronary arteriography and coronary artery bypass grafting.