ABSTRACT
STUDY 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. DESIGN: Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission. SETTING: Random sample of 94 district general hospitals in the UK. PATIENTS: 1064 patients under 70 years old recruited between April 1995 and November 1996. MAIN 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.
Subject(s)
Coronary Disease/therapy , Health Care Rationing/statistics & numerical data , Prejudice , Acute Disease , Adult , Aged , Angioplasty, Balloon, Coronary/statistics & numerical data , Coronary Artery Bypass/statistics & numerical data , Coronary Disease/diagnosis , Coronary Disease/rehabilitation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Selection , Prognosis , Prospective Studies , Quality of Life , Risk Factors , Sex Factors , Surveys and Questionnaires , Treatment Outcome , United KingdomSubject(s)
Bone Neoplasms/diagnosis , Chondroma/diagnosis , Finger Injuries/diagnosis , Tendon Injuries , Bone Neoplasms/complications , Bone Neoplasms/surgery , Bone Transplantation , Chondroma/complications , Chondroma/surgery , Diagnosis, Differential , Finger Injuries/etiology , Finger Injuries/surgery , Humans , Prognosis , Rupture/diagnosis , Rupture, Spontaneous/diagnosis , Tendons/surgery , Treatment OutcomeABSTRACT
We conducted a retrospective cohort study based on a case note review to determine whether there are differences in the treatment pathways followed for men and women admitted with acute myocardial ischemia and infarction after adjusting for differences in case mix. Women were as likely as men to receive thrombolysis, but were less likely subsequently to undergo exercise testing (adjusted odds ratio, 0.58; 95% CI, 0.40-0.84) or angiography (adjusted odds ratio, 0.62; 95% CI, 0.39-0.99). Coronary anatomy was the strongest predictor of revascularization regardless of sex. Women with diagnosed cardiac pain are less likely than men to be placed on the investigative pathways that lead to revascularization. Those women who are investigated are as likely as men to undergo revascularization. These findings are independent of the effects of age, angina grade, comorbidity, or cardiac risk factors. Clinicians' and patients' beliefs and preferences about treatment require investigation.
