title: Cardiology services after stress testing: are there sex differences? A population-based study.
abstract: To test the hypothesis that, in a population-based cohort of persons undergoing stress tests, female sex was negatively associated with the use of cardiology visits in persons with no documented coronary artery disease (CAD) but that this association did not exist when CAD was established. Sex differences in the use of invasive cardiac procedures have been clearly documented, but data on physician encounters, an integral part of care, are lacking. A population-based cohort consisting of all Olmsted County, Minnesota residents who underwent an initial stress test in 1987, 1988, and 1989 in Olmsted County was examined. Medical records were reviewed for baseline characteristics including CAD diagnosis status, test results, and cardiology visits in the year following the stress test. Regression models were constructed to determine whether sex is independently associated with the probability of a visit. In the year after stress testing, there was no difference between the sexes in the use of inpatient (OR for female sex 0.88, 95% CI 0.62-0.97, P = 0.365) and outpatient/consultative (OR for female sex 1.24, 95% CI 0.95-1.61, P = 0.6) cardiology visits. Women were, however, less likely to receive preventive cardiology visits (OR for female sex 0.77, 95% CI 0.62-0.97, P = 0.02). This was largely related to less use of preventive visits among older women with documented coronary artery disease (CAD). In the absence of documented CAD, when the stress test was positive, women were less likely to receive preventive visits. In this geographically defined population within one year after an initial stress test, there was no sex difference in the use of in-patient or out-patient visits but women were less likely to receive preventive cardiology visits in the year after stress testing. Further studies are needed to understand the reasons for and impact of these care patterns.
authors.affiliation: Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Daly
authors.forename: V L
authors.initials: VL
authors.lastname: Roger
authors.forename: C
authors.initials: C
authors.lastname: Leibson
authors.forename: T D
authors.initials: TD
authors.lastname: Miller
authors.forename: P A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: K
authors.initials: K
authors.lastname: Bailey
authors.forename: S J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D002309:Cardiology; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005080:Exercise Test; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012737:Sex Factors; D016387:Women's Health