Sex bias in cardiovascular testing: The contribution of patient preference

Bryn E. Mumma, Brigitte M. Baumann, Deborah B. Diercks, Kevin M. Takakuwa, Caren F. Campbell, Frances S. Shofer, Anna Marie Chang, Molly K. Jones, Judd E. Hollander

Research output: Contribution to journalArticle

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Abstract

Study objective Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. Methods We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. Results One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} 0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference 10% [95% CI 15% to 4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference 13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference 7%; 95% CI for the difference 13% to 1.5%) and cardiac catheterization (10% versus 17%; difference 7% [95% CI 11% to 2%]). Revascularization was infrequent in both groups (4% versus 6%; difference 2% [95% CI 5% to 0.6%]). Conclusion Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume57
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

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Sexism
Patient Preference
Confidence Intervals
Cardiac Catheterization
Routine Diagnostic Tests
Physicians
Acute Coronary Syndrome
Exercise Test
Percutaneous Coronary Intervention
Coronary Artery Bypass
Catheterization
Hearing
Hospital Emergency Service
Hospitalization
Cohort Studies
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Mumma, B. E., Baumann, B. M., Diercks, D. B., Takakuwa, K. M., Campbell, C. F., Shofer, F. S., ... Hollander, J. E. (2011). Sex bias in cardiovascular testing: The contribution of patient preference. Annals of Emergency Medicine, 57(6). https://doi.org/10.1016/j.annemergmed.2010.09.026

Sex bias in cardiovascular testing : The contribution of patient preference. / Mumma, Bryn E.; Baumann, Brigitte M.; Diercks, Deborah B.; Takakuwa, Kevin M.; Campbell, Caren F.; Shofer, Frances S.; Chang, Anna Marie; Jones, Molly K.; Hollander, Judd E.

In: Annals of Emergency Medicine, Vol. 57, No. 6, 06.2011.

Research output: Contribution to journalArticle

Mumma, BE, Baumann, BM, Diercks, DB, Takakuwa, KM, Campbell, CF, Shofer, FS, Chang, AM, Jones, MK & Hollander, JE 2011, 'Sex bias in cardiovascular testing: The contribution of patient preference', Annals of Emergency Medicine, vol. 57, no. 6. https://doi.org/10.1016/j.annemergmed.2010.09.026
Mumma, Bryn E. ; Baumann, Brigitte M. ; Diercks, Deborah B. ; Takakuwa, Kevin M. ; Campbell, Caren F. ; Shofer, Frances S. ; Chang, Anna Marie ; Jones, Molly K. ; Hollander, Judd E. / Sex bias in cardiovascular testing : The contribution of patient preference. In: Annals of Emergency Medicine. 2011 ; Vol. 57, No. 6.
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abstract = "Study objective Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. Methods We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. Results One thousand eighty patients enrolled; 652 (60{\%}) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58{\%} versus men 52{\%}; difference 6{\%} [95{\%} confidence interval {CI} 0.06{\%} to 12{\%}]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85{\%} for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65{\%} versus 75{\%}; difference 10{\%} [95{\%} CI 15{\%} to 4{\%}]). Women were 6{\%} less likely (67{\%} versus 73{\%}; 95{\%} CI for difference 12{\%} to 0.5{\%}) to accept percutaneous coronary intervention over medical therapy and 7{\%} less likely (61{\%} versus 68{\%}; 95{\%} CI for difference 13{\%} to 1{\%}) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38{\%} versus 45{\%}; difference 7{\%}; 95{\%} CI for the difference 13{\%} to 1.5{\%}) and cardiac catheterization (10{\%} versus 17{\%}; difference 7{\%} [95{\%} CI 11{\%} to 2{\%}]). Revascularization was infrequent in both groups (4{\%} versus 6{\%}; difference 2{\%} [95{\%} CI 5{\%} to 0.6{\%}]). Conclusion Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.",
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AU - Shofer, Frances S.

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N2 - Study objective Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. Methods We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. Results One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} 0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference 10% [95% CI 15% to 4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference 13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference 7%; 95% CI for the difference 13% to 1.5%) and cardiac catheterization (10% versus 17%; difference 7% [95% CI 11% to 2%]). Revascularization was infrequent in both groups (4% versus 6%; difference 2% [95% CI 5% to 0.6%]). Conclusion Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.

AB - Study objective Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. Methods We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. Results One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} 0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference 10% [95% CI 15% to 4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference 13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference 7%; 95% CI for the difference 13% to 1.5%) and cardiac catheterization (10% versus 17%; difference 7% [95% CI 11% to 2%]). Revascularization was infrequent in both groups (4% versus 6%; difference 2% [95% CI 5% to 0.6%]). Conclusion Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.

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