Men Have More Heart Tests

Women less likely to get cardiac catheterization after a heart attack, regardless of their doctor's gender, says study

TUESDAY, Dec. 11, 2001 (HealthDayNews) -- The quickest way to a man's heart appears to be through a catheter. Not so for a woman.

Women who've had a heart attack are about 10 percent less likely than men to undergo cardiac catheterization, regardless of the gender of their doctor, a new study says.

Gender splits among doctors have been seen before in therapies, including mammography and Pap smears, which are tests male doctors seem less likely to order than female doctors. And the issue of gender discrepancy in cardiac care isn't new. But researchers hadn't known whether the tilt is the result of male physicians minimizing female complaints -- or something more subtle.

Dr. Michael Lauer, a cardiologist at the Cleveland Clinic in Ohio and a contributing editor at the Journal of the American Medical Association, calls the new findings "fairly reassuring. It doesn't appear that there's a specific bias that male doctors have against female patients." The study appears in the Dec. 12 JAMA.

The mystery, however, is why the gender difference exists, and whether it's leading to harm.

"It is a huge issue, because it raises the question as to whether more than half the population are not getting appropriate care solely because of the fact that they're women," Lauer says.

Some evidence suggests that women are more likely than men to die after bypass surgery and heart attacks, Lauer says, but whether that has anything to do with treatment differences isn't clear.

The study, led by Saif Rathore, of Yale University School of Medicine in New Haven, examined catheterization rates among more than 104,000 Medicare patients who'd suffered heart attacks between 1994 and 1995. Most of the patients were women and men treated by male doctors, but about 7,000 had female physicians.

Cardiac catheterization involves threading a tiny tube through a blood vessel that leads to the heart. By using dye and X-rays, a doctor can then see how well the heart is working.

Cardiologists use catheters in heart attack care for two reasons. The first is to find blocked arteries that might be causing an ongoing episode; the second is to locate potential trouble spots that might put patients at risk of a second event. If such obstructions exist, doctors can then perform procedures to clear or route blood around the narrowing.

The study found that women who were treated by male doctors were about 12 percent less likely than men -- 38.6 percent vs. 50.8 percent -- to undergo catheterization in the two months after their heart attack, the researchers say. But a similar diffference held when the cardiologist was a woman.

However, there was a gender discrepancy: Patients of either gender were more likely to receive the therapy if their doctor was a man, while women who saw female doctors had the lowest rate of catheterization.

After adjusting for various factors, including medical history and symptoms upon admission to the hospital, the researchers say women were about 10 percent less likely to undergo catheterization than men.

Dr. Harlan Krumholz, a Yale cardiologist and senior author of the paper, says that although the difference exists, he's not sure it's significant.

"I'm not prepared to say which group is getting under-use and which is getting overuse" of catheterization, Krumholz says. "Are women suffering because they have a lower cardiac catheterization rate than men? Is there evidence that people who definitely should have gotten it didn't get it?"

Although the researchers can't say which is the case, Krumholz says something must account for the disparity. "Does it represent preferences and values expressed by women patients to physicians? Or is there some sort of relatively modest but systematic" difference in practice?

Dr. Paul Heidenreich, a Stanford University cardiologist, agrees that the meaning of the latest findings is murky.

"It is not clear that the disparity in [catheterization rate] is harmful. Some procedures are not needed, while others are important to improving survival. Together, the effect may be neutral," he says.

However, Heidenreich adds that as women become more involved in their health care decisions, the disparity may fade.

What To Do

To learn more about cardiac catheterization, try Torrance Memorial Medical Center or the Cardiologychannel.

For an excellent explanation of cardiac catheterization, try this site from Hall-Garcia Cardiology Associates.

For more on what happens after a heart attack, try healthAtoZ.

SOURCES: Interviews with Harlan Krumholz, M.D., associate professor of medicine, Yale University School of Medicine, New Haven, Conn.; Michael S. Lauer, M.D., director of clinical research, department of cardiology, Cleveland Clinic, and contributing editor, Journal of the American Medical Association; Paul Heidenreich, M.D., assistant professor, Stanford University School of Medicine, Stanford, Calif.; Dec. 12, 2001 JAMA
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