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Do Women with Heart Attacks Get Fewer Heart Procedures Than Men? FREE

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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.

Ann Intern Med. 2002;137(6):I-26. doi:10.7326/0003-4819-137-6-200209170-00002
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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.





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