Coronary artery surgery: are women discriminated against?

Petticrew, Mark; McKee, Martin; Jones, Jared R.

doi:10.1136/bmj.306.6886.1164

Cited by 109 publications

(47 citation statements)

References 23 publications

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“…Despite this, no difference was observed in the prescription of anti-anginal medication. In several other studies from the U.S.A., England, Ireland and Canada, these findings have been verified both for the investigation of suspected coronary artery disease and after hospital care for manifest disease [51][52][53][54][55] . To my knowledge, no similar study has been carried out in Scandinavia.…”

Section: Gender Differences In the Use Of Diagnostic Tests And Therapsupporting

confidence: 52%

The care of patients with ischaemic heart disease from a gender perspective

Swahn

1998

European Heart Journal

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Section: Gender Differences In the Use Of Diagnostic Tests And Therapsupporting

confidence: 52%

The care of patients with ischaemic heart disease from a gender perspective

Swahn

1998

European Heart Journal

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“…378 Reasons commonly given for the lower CABG rates in women include more comorbidity, which augments their operative risk, and smaller coronary arteries, which present greater technical challenges and increase the potential for incomplete revascularization.…”

Section: Cardiac Procedures Rates In All Patients With Cadmentioning

confidence: 99%

A comprehensive view of sex-specific issues related to cardiovascular disease

Pilote¹,

Dasgupta²,

Guru³

et al. 2007

Canadian Medical Association Journal

375

256

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A comprehensive view of sex-specific issues related to cardiovascular disease Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown. CMAJ 2007;176(6):S1-44 Although cardiovascular disease (CVD) is common, significant sex-related differences in its epidemiology have only recently been appreciated. The objective of this section is to demonstrate that there are sex-specific differences in the prevalence, complications and burden of CVD in terms of mortality, hospital admissions and quality of life. Abstract Search strategyA MEDLINE search was conducted using the MeSH terms "cardiovascular disease" OR "atrial fibrillation" OR "congestive heart failure." A second search used the terms "prevalence" OR "incidence" OR "mortality" and the final search combined the results of the first 2 searches and added the terms "gender" OR "sex." Articles identified in this manner were retrieved and their reference lists searched for additional relevant articles. The search was limited to English-language publications, but no other restrictions were applied. Other data sources included Web sites of the World Health Organization, the Canadian Institute for Health Information and the National Centre for Health Statistics. Thirty-three original studies were reviewed. Studies were included if they were cohort studies, case-control studies or nested cohort studies that examined the incidence, prevalence or mortality of CVD, congestive heart failure or atrial fibrillation. The studies had to include data on both ...

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Bias in the medical system 13 and unmeasured clinical factors 14 have been cited as possible explanations for these differences. Although patients' attitudes are often important factors in medical decision making, [15][16][17][18] little attention has been devoted to these attitudes as potential mediators of gender differences in invasive treatments.…”

Section: Methodsmentioning

confidence: 99%

Attitudes About Treatment of Coronary Heart Disease Among Women and Men Presenting for Exercise Testing

Ayanian

Epstein

1997

J Gen Intern Med

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To assess attitudes that could contribute to gender differences in the use of coronary procedures, we surveyed 322 patients presenting for exercise testing at a major teaching hospital. Adjusting for sociodemographic and clinical factors, women and men did not differ significantly in their willingness to seek a second opinion, reduce physical activity, or take drugs to avoid major cardiac surgery, but men were more likely than women to describe themselves as risk takers on a three-item personality measure (adjusted odds ratio 2.5; 95% confidence interval 1.4-4.6). Patients' attitudes about risk should be explored further in studies of gender differences in the use of coronary procedures. METHODSHospitalized and ambulatory patients presenting for exercise testing at Brigham and Women's Hospital during July and August 1993 were eligible for the study. The survey, available in English and Spanish, was completed by subjects before or immediately after exercise testing, prior to discussing test results with their physicians. It assessed willingness to reduce activity or take drugs to avoid major heart surgery, desire for second opinions before major surgery, and three attitudes about risk taking adapted from the Jackson Personality Inventory (Appendix A). 20 Other questions addressed sociodemographic characteristics, overall health, cardiovascular diagnoses and risk factors, past coronary procedures, and cardiac functional status. 21 Data on age, gender, cardiac drug use, and results of exercise testing were obtained from exercise test reports. Subsequent performance of coronary angiography within 90 days was determined from the hospital's computer system. Because referring physicians worked full-time at this hospital or at a staff-model health maintenance organization that directs patients to this hospital for major cardiac procedures, almost all angiography within 90 days would have been performed at this hospital.We compared sociodemographic and clinical variables and attitudes by gender using the 2 test, Fisher's Exact Test, or Student's t test as appropriate. We used logistic regression to assess whether attitudes differ by gender, adjusting for age, race, Hispanic ethnicity, education, income, marital status, living alone, history of myocardial infarction and angina, Specific Activity Scale class, and previous coronary procedures. We also analyzed the use of coronary angiography by attitudes, using logistic regression to adjust for gender, age, exercise test results, and history of myocardial infarction.With a 5% ␣ error, these analyses had 80% power to detect differences of 15% (60% vs 75%) in the proportions of women and men reporting a specific attitude or 10% (5% vs 15%) in the proportions of persons with differing attitudes undergoing angiography; power to detect smaller differences in use of angiography was limited. Two-tailed p values or adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are reported for all results. RESULTSOf the 407 eligible patients, 322 (79.1%) completed the written surv...

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Coronary artery surgery: are women discriminated against?

Cited by 109 publications

References 23 publications

The care of patients with ischaemic heart disease from a gender perspective

The care of patients with ischaemic heart disease from a gender perspective

A comprehensive view of sex-specific issues related to cardiovascular disease

Attitudes About Treatment of Coronary Heart Disease Among Women and Men Presenting for Exercise Testing

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