 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Do Women with Heart Attacks Get Fewer Heart Procedures Than Men?
17 September 2002 | Volume 137 Issue 6 | Page I-26
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Sex Differences in Cardiac Catheterization after Acute Myocardial Infarction: The Role of Procedure Appropriateness." It is in the 17 September 2002 issue of Annals of Internal Medicine (volume 137, pages 487-493). The authors are SS Rathore, Y Wang, MJ Radford, DL Ordin, and HM Krumholz.
What is the problem and what is known about it so far?
Heart attacks occur when blood flow through the arteries to the heart (coronary arteries) is blocked for a long enough time to damage or kill a portion of heart muscle. Within days to months after the heart attack, doctors sometimes inject dye through a catheter into the coronary arteries (heart catheterization) to see where they are narrowed or blocked. Doctors do the catheterization to find out whether patients need major procedures (coronary artery bypass graft surgery or angioplasty) to help prevent future heart attacks and chest pain (angina). Some patients with heart attacks do not need catheterizations. They may have very low risks for future problems, or they may have other illnesses, such as liver failure, which preclude heart surgery. Some, but not all, research suggests that women in the United States have catheterizations after heart attacks less often than men. Even if women have these procedures less often than men, we do not know whether the procedures are inappropriately underused in women compared with men.
Why did the researchers do this particular study?
To find out whether women had catheterizations after heart attacks less often than men and, if so, whether this was due to inappropriate treatment.
Who was studied?
143 444 Medicare patients hospitalized for heart attacks between 1994 and 1996.
How was the study done?
The researchers used Medicare data to identify adults older than 65 years of age who had been discharged from hospitals with a diagnosis of heart attack. The researchers reviewed medical records of the patients and classified them as having strong, equivocal, or weak indications for heart catheterization. For example, they marked "strong indication" if the procedure would be likely to benefit the patient and "weak indication" if it was unlikely to benefit the patient. The researchers used standard criteria that had been developed by experts to make the judgments about indications. The researchers also reviewed medical and billing records to see which patients had heart catheterizations within 60 days of their heart attack. Then, they compared rates of catheterizations between women and men with different indications for the procedure.
What did the researchers find?
Overall, fewer women (36%) than men (47%) had heart catheterizations. However, women and men with strong indications for the procedure had the same rates of catheterizations (44%). Women and men with weak indications also had similar rates (about 17%). Slightly fewer women (39%) than men (43%) with equivocal indications had heart catheterizations.
What were the limitations of the study?
The researchers used data from medical records to decide whether procedures were indicated. Some patients may have had indications that were not recorded accurately.
What are the implications of the study?
Fewer women than men have heart catheterizations within 60 days of a heart attack. However, differences in rates of the procedure probably often reflect appropriate clinical decisions rather than gender bias.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  N. Sekhri, A. Timmis, R. Chen, C. Junghans, N. Walsh, J. Zaman, S. Eldridge, H. Hemingway, and G. Feder Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris BMJ, May 10, 2008; 336(7652): 1058 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. McInnes, C. McAlpine, and M. Walters Effect of gender on stroke management in Glasgow Age Ageing, March 1, 2008; 37(2): 220 - 222. [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Ko, Y. Wang, D. A. Alter, J. P. Curtis, S. S. Rathore, T. A. Stukel, F. A. Masoudi, J. S. Ross, J. M. Foody, and H. M. Krumholz Regional Variation in Cardiac Catheterization Appropriateness and Baseline Risk After Acute Myocardial Infarction. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 716 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Rudd, A. Hoffman, C. Down, M. Pearson, and D. Lowe Access to stroke care in England, Wales and Northern Ireland: the effect of age, gender and weekend admission Age Ageing, May 1, 2007; 36(3): 247 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Nicholls, K. Wolski, I. Sipahi, P. Schoenhagen, T. Crowe, S. R. Kapadia, S. L. Hazen, E. M. Tuzcu, and S. E. Nissen Rate of Progression of Coronary Atherosclerotic Plaque in Women J. Am. Coll. Cardiol., April 10, 2007; 49(14): 1546 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Pilote, K. Dasgupta, V. Guru, K. H. Humphries, J. McGrath, C. Norris, D. Rabi, J. Tremblay, A. Alamian, T. Barnett, et al. A comprehensive view of sex-specific issues related to cardiovascular disease Can. Med. Assoc. J., March 13, 2007; 176(6): S1 - S44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ross, V. Ho, Y. Wang, S. S. Cha, A. J. Epstein, F. A. Masoudi, B. K. Nallamothu, and H. M. Krumholz Certificate of Need Regulation and Cardiac Catheterization Appropriateness After Acute Myocardial Infarction Circulation, February 27, 2007; 115(8): 1012 - 1019. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Milcent, B. Dormont, I. Durand-Zaleski, and P. G. Steg Gender Differences in Hospital Mortality and Use of Percutaneous Coronary Intervention in Acute Myocardial Infarction: Microsimulation Analysis of the 1999 Nationwide French Hospitals Database Circulation, February 20, 2007; 115(7): 833 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, C. N. Bairey Merz, C. J. Pepine, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S4 - S20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. N. Bairey Merz, L. J. Shaw, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, C. J. Pepine, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: Gender Differences in Presentation, Diagnosis, and Outcome With Regard to Gender-Based Pathophysiology of Atherosclerosis and Macrovascular and Microvascular Coronary Disease J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S21 - S29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Anand, C. C. Xie, S. Mehta, M. G. Franzosi, C. Joyner, S. Chrolavicius, K. A.A. Fox, S. Yusuf, and for the CURE Investigators Differences in the Management and Prognosis of Women and Men Who Suffer From Acute Coronary Syndromes J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1845 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Martinez-Selles, R. Lopez-Palop, E. Perez-David, and H. Bueno Influence of Age on Gender Differences in the Management of Acute Inferior or Posterior Myocardial Infarction Chest, August 1, 2005; 128(2): 792 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Lansky, J. S. Hochman, P. A. Ward, G. S. Mintz, R. Fabunmi, P. B. Berger, G. New, C. L. Grines, C. G. Pietras, M. J. Kern, et al. Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association Circulation, February 22, 2005; 111(7): 940 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Procedure Appropriateness Explains Sex Differences in Cath Use After MI Journal Watch Cardiology, November 8, 2002; 2002(1108): 3 - 3. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
