Treating heart attacks in women: does it matter if the doctor is male or female?
A number of studies have found that female heart attack patients are less likely to undergo certain cardiac procedures, such as cardiac catheterization, than male patients. A recent study published in the Journal of the American Medical Association found that although female heart attack patients are less likely to undergo cardiac catheterization, female physicians were no more likely than their male counterparts to order this test for their female patients.
About the study
Researchers from the medical schools at Yale University, Emory University and the University of Pennsylvania analyzed data from the medical records of patients in the Cooperative Cardiovascular Project (CCP). This project included 234,769 fee-for-service Medicare patients who had been hospitalized for heart attack in non-government, acute care hospitals between January 1994 and February 1995. The researchers were trying to determine if male physicians ordered cardiac catheterization for female patients less often than female physicians.
A number of patient medical records from the CCP were excluded from this study, reducing the total number of patient records analyzed to 104,231. Records were excluded for several reasons, such as a re-admission record, the patient having previously undergone invasive cardiac procedures, or a life expectancy of less than six months. In addition, records were excluded if the treating physician was a cardiothoracic surgeon, which could increase the likelihood of invasive procedures.
The medical records were grouped into four categories:
- Female patients treated by a male physician (48.4%)
- Male patients treated by a male physician (44.9%)
- Female patients treated by a female physician (4.1%)
- Male patients treated by a female physician (2.6%)
Researchers compared how often cardiac catheterization was ordered for male and female patients by male physicians, versus how often the procedure was ordered for both men and women by female physicians.
Female patients underwent fewer cardiac catheterizations than male patients regardless of whether the physician was male or female. Male physicians ordered the procedure for 38.6% of women and 50.8% of men. Female physicians ordered the procedure for 34.8% of women and 45.8% of men. Although some research has suggested that women refuse invasive procedures such as cardiac catheterization more frequently than men, treatment differences between men and women in this study were unchanged when refusal of the procedure was accounted for.
These findings support previous research findings indicating that women who suffer heart attacks are less likely to undergo cardiac catheterization than men. However, the findings also indicate that female physicians order cardiac catheterization less frequently than male physicians, regardless of the sex of the patient.
Analysis of this data showed that the likelihood of a heart attack patient undergoing cardiac catheterization was not affected by the sex of his or her physician. The patients most likely to have cardiac catheterization were male patients treated by male physicians. And the patients least likely to have the procedure were female patients treated by female physicians.
Several limitations in the design of this study are worth noting. First, the study looked at heart attack patients who were over age 65 and insured by Medicare, so we do not know if these results apply to younger cardiac patients and those who have private health insurance. Second, the researchers were unable to measure the effect of other physicians in the care of each patient. The medical record lists the name of the treating physician, but there is no way of knowing who else that physician consulted when deciding on whether to order cardiac catheterization. In addition, the medical record does not list whether the treating physician has subspecialty training in invasive cardiology, which might affect his or her decision to order cardiac catheterization.
How does this affect you?
Though worthy of further investigation, the findings of this study are not likely to have a direct impact on the care you would receive in the hospital should you suffer a heart attack. The findings do, however, support the notion that female heart attack patients are less likely to undergo cardiac catheterization. However, this does not necessarily mean that female heart attack patients are receiving substandard care. There is currently no definitive standard of when it is appropriate to order cardiac catheterization for a heart attack patient. The attending physician makes a judgment based on accepted guidelines for treating cardiac patients. Determining whether female heart attack patients receive substandard care is a question for another study to answer.
Rathore SS, et al. Sex differences in cardiac catheterization: the role of physician gender.
Journal of the American Medical Association . December 12, 2001. 286(22):2849-2856.
Last reviewed Dec 21, 2001 by ]]>Richard Glickman-Simon, MD]]>
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