Gender differences in the management and outcome of patients with acute coronary artery disease.
OBJECTIVE
s: To compare the clinical management and health outcomes of men and women after admission with acute coronary syndromes, after adjusting for disease severity, sociodemographic, and cardiac risk factors.


METHODS
Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission.


METHODS
Random sample of 94 district general hospitals in the UK.


METHODS
1064 patients under 70 years old recruited between April 1995 and November 1996.


RESULTS
Of the 1064 patients recruited, 126 (11.8%) died before follow up. Of the 938 survivors, 719 (76.7%) completed a follow up questionnaire. There were no gender differences in the use of cardiac investigations during the index admission or follow up period. However, male patients with hypertension were more likely to undergo rehabilitation compared with female hypertensive patients (OR 2.01, 95% CI 0.85 to 4.72). Men were also more likely to undergo coronary artery bypass grafting (CABG) than women (OR 1.90, 95%CI 1.21 to 3.00), but there was no gender difference in the use of revascularisation overall (p=0.14). An indirect indication that the gender differences in CABG were not attributable to bias was provided by the lack of gender differences in health outcomes, which implies that patients received the care they needed.


CONCLUSIONS
Despite the extensive international literature referring to a gender bias in favour of men with coronary heart disease, this national survey found no gender differences in the use of investigations or in revascularisation overall. However, the criteria used for selecting percutaneous transluminal coronary angioplasty compared with CABG requires further investigation as does the use of rehabilitation. It is unclear whether the clinical decisions to provide these procedures are made solely on the basis of clinical need.
Raine
R A
RA
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. rosalind.raine@lshtm.ac.uk
Black
N A
NA
Bowker
T J
TJ
Wood
D A
DA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011287:Prejudice; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom