Women Twice as Likely as Men to be Referred to the Cath Lab
Last Updated: 2010-03-17 16:39:54 -0400 (Reuters Health)
ATLANTA (Reuters Health) - In what appears to be a huge shift in clinical practice, women with suspected heart disease are being referred for cardiac catheterization twice as often as men, according to data presented here at the 59th scientific sessions of the American College of Cardiology.
For years, women presenting with chest pain to emergency departments were sent home without further investigation, but it appears that times are changing, said lead investigator Dr. Marcelo Di Carli, from Brigham and Women's Hospital in Boston. "A lot of effort has been put into raising awareness about heart disease in women. It appears now that this is beginning to bear fruit."
Dr. Di Carli and his colleagues analyzed 90-day referral rates in 891 women and 812 men who were enrolled in SPARC, an ongoing registry study of trends in resource utilization across the United States.
The patients underwent cardiovascular imaging tests, including single photon emission computed tomography, positron emission tomography, and coronary computed tomographic angiography. Thirty percent of women and 22% of men had abnormal test results (p < 0.001).
The overall referral rate for cardiac catheterization was 10%, with gender-specific rates of 13% in women and 6% in men (p <0.001).
After adjusting for age, diabetes, test result, type of imaging test and chest pain, female sex remained a significant predictor of referral to cardiac catheterization.
"The big question now is whether this increased referral to cath reflects overuse, appropriate use, or under-use in men," said Dr. Di Carli. "This was something we could not answer because we don't have a standard of appropriateness for referral to cath."
What does seem to be happening is that the long-standing bias against women and heart disease is reversing, he said.
"Physicians may be more aware that women present with more atypical symptoms and recognize that those symptoms may reflect coronary disease. People are starting to pay more attention."
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