Sex preferences in cardiovascular testing

The contribution of the patient-physician discussion

Katie E. Golden, Anna Marie Chang, Judd E. Hollander

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing. Methods This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing. Results There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8% vs. 20.0%, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5% vs. 19.3%, p = 0.02) or cardiac catheterization (4.2% vs. 13.6%, p = 0.02) or to see a cardiologist (8.5% vs. 22.7%, p <0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5% vs. 50.0%, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1% vs. 22.7%, p = 0.03), as inpatients (11.5% vs. 40.0%, p <0.01), and as outpatients (26.1% vs. 48.6%, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1% vs. 15.9%, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7% vs. 40.0%, p = 0.02). Conclusions Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.

Original languageEnglish (US)
Pages (from-to)680-688
Number of pages9
JournalAcademic Emergency Medicine
Volume20
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Physicians
Hospital Emergency Service
Patient Preference
Inpatients
Cardiac Catheterization
Acute Coronary Syndrome
Chest Pain
Coronary Artery Disease
Patient Discharge
Catheterization
Sex Characteristics
Counseling
Cohort Studies
Outpatients
Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Sex preferences in cardiovascular testing : The contribution of the patient-physician discussion. / Golden, Katie E.; Chang, Anna Marie; Hollander, Judd E.

In: Academic Emergency Medicine, Vol. 20, No. 7, 07.2013, p. 680-688.

Research output: Contribution to journalArticle

Golden, Katie E. ; Chang, Anna Marie ; Hollander, Judd E. / Sex preferences in cardiovascular testing : The contribution of the patient-physician discussion. In: Academic Emergency Medicine. 2013 ; Vol. 20, No. 7. pp. 680-688.
@article{af0f02cc82664a92ba57d09ae9592241,
title = "Sex preferences in cardiovascular testing: The contribution of the patient-physician discussion",
abstract = "Objectives Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing. Methods This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing. Results There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8{\%} vs. 20.0{\%}, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5{\%} vs. 19.3{\%}, p = 0.02) or cardiac catheterization (4.2{\%} vs. 13.6{\%}, p = 0.02) or to see a cardiologist (8.5{\%} vs. 22.7{\%}, p <0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5{\%} vs. 50.0{\%}, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1{\%} vs. 22.7{\%}, p = 0.03), as inpatients (11.5{\%} vs. 40.0{\%}, p <0.01), and as outpatients (26.1{\%} vs. 48.6{\%}, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1{\%} vs. 15.9{\%}, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7{\%} vs. 40.0{\%}, p = 0.02). Conclusions Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.",
author = "Golden, {Katie E.} and Chang, {Anna Marie} and Hollander, {Judd E.}",
year = "2013",
month = "7",
doi = "10.1111/acem.12169",
language = "English (US)",
volume = "20",
pages = "680--688",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Sex preferences in cardiovascular testing

T2 - The contribution of the patient-physician discussion

AU - Golden, Katie E.

AU - Chang, Anna Marie

AU - Hollander, Judd E.

PY - 2013/7

Y1 - 2013/7

N2 - Objectives Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing. Methods This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing. Results There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8% vs. 20.0%, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5% vs. 19.3%, p = 0.02) or cardiac catheterization (4.2% vs. 13.6%, p = 0.02) or to see a cardiologist (8.5% vs. 22.7%, p <0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5% vs. 50.0%, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1% vs. 22.7%, p = 0.03), as inpatients (11.5% vs. 40.0%, p <0.01), and as outpatients (26.1% vs. 48.6%, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1% vs. 15.9%, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7% vs. 40.0%, p = 0.02). Conclusions Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.

AB - Objectives Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing. Methods This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing. Results There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8% vs. 20.0%, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5% vs. 19.3%, p = 0.02) or cardiac catheterization (4.2% vs. 13.6%, p = 0.02) or to see a cardiologist (8.5% vs. 22.7%, p <0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5% vs. 50.0%, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1% vs. 22.7%, p = 0.03), as inpatients (11.5% vs. 40.0%, p <0.01), and as outpatients (26.1% vs. 48.6%, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1% vs. 15.9%, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7% vs. 40.0%, p = 0.02). Conclusions Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.

UR - http://www.scopus.com/inward/record.url?scp=84880267546&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880267546&partnerID=8YFLogxK

U2 - 10.1111/acem.12169

DO - 10.1111/acem.12169

M3 - Article

VL - 20

SP - 680

EP - 688

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 7

ER -