Saif S. Rathore, MPH; Yongfei Wang, MS; Martha J. Radford, MD; Diana L. Ordin, MD, MPH; Harlan M. Krumholz, MD, SM
Disclaimer: The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organization imply endorsement by the U.S. government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services (formerly Health Care Financing Administration), which has encouraged identification of quality improvement projects derived from analysis of patterns of care and, therefore, required no special funding on the part of this contractor.
Acknowledgments: The authors thank Maria Johnson, BA, for editorial assistance and Jeph Herrin, PhD, for statistical assistance.
Grant Support: By the Centers for Medicare & Medicaid Services (CMS, formerly the Health Care Financing Administration), U.S. Department of Health and Human Services (contract number 500-99-CTO1: “Utilization and Quality Control Peer Review Organization for the State of Connecticut”).
Corresponding Author: Harlan Krumholz, MD, Department of Internal Medicine, Room IE-61 SHM, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025; email, email@example.com.
Current Author Addresses: Mr. Rathore, Mr. Wang, and Drs. Radford and Krumholz: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, Room I-456 SHM, PO Box 208025, New Haven, CT 06520-8025.
Dr. Ordin: Centers for Medicare & Medicaid Services Boston Regional Office, Government Center, JFK Federal Building, Room 2350, Boston, MA 02203.
Author Contributions: Conception and design: S.S. Rathore, H.M. Krumholz.
Analysis and interpretation of the data: S.S. Rathore, Y. Wang, H.M. Krumholz.
Drafting of the article: S.S. Rathore.
Critical revision of the article for important intellectual content: S.S. Rathore, Y. Wang, M.J. Radford, D.L. Ordin, H.M. Krumholz.
Final approval of the article: S.S. Rathore, Y. Wang, M.J. Radford, D.L. Ordin, H.M. Krumholz.
Provision of study materials or patients: H.M. Krumholz.
Statistical expertise: S.S. Rathore, Y. Wang, H.M. Krumholz.
Obtaining of funding: M.J. Radford, H.M. Krumholz.
Administrative, technical, or logistic support: M.J. Radford, D.L. Ordin, H.M. Krumholz.
Rathore SS, Wang Y, Radford MJ, Ordin DL, Krumholz HM. Sex Differences in Cardiac Catheterization after Acute Myocardial Infarction: The Role of Procedure Appropriateness. Ann Intern Med. 2002;137:487-493. doi: 10.7326/0003-4819-137-6-200209170-00008
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Published: Ann Intern Med. 2002;137(6):487-493.
Data on sex variations in use of cardiac catheterization after an acute myocardial infarction are mixed, with some studies reporting that the procedure is used less often in women (1-13) and others finding no sex differences in use of the procedure (9, 14-19). Despite these conflicting findings, some observers have suggested that sex variations in cardiac care are evidence of sexual discrimination by physicians (20, 21) and reflect a pervasive gender bias in the health care system (22). Although studies of cardiac catheterization use have examined the effect of clinical (1-6, 8, 10, 12, 13, 23), hospital (5, 8, 13), and payer characteristics on sex differences in cardiac procedure use (1-5, 8, 10, 13), few have investigated the contribution of procedure appropriateness to sex differences in procedure use. Without considering the appropriateness of cardiac catheterization for an individual patient, it is unclear whether sex variations in cardiac catheterization use reflect proper clinical practice based on a difference of need, undertreatment of women, overtreatment of men, or a combination of factors. The few studies that have examined sex differences in cardiac catheterization use after adjusting for appropriateness of the procedure have included small numbers of patients from single centers or other selected populations and have reported conflicting results (18, 24-26). Thus, the extent to which sex differences in cardiac catheterization use after an acute myocardial infarction may be attributed to sex differences in appropriateness of the procedure is unknown.
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Cardiology, Emergency Medicine, Cardiac Diagnosis and Imaging, Acute Coronary Syndromes, Coronary Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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