Document Detail


Coronary artery bypass graft surgery and primary percutaneous coronary intervention choices in patients with similar coronary anatomy: A computer-based simulation examines the sex gap.
MedLine Citation:
PMID:  19898697     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Sex differences (or a 'sex gap') exist in the rates of cardiac revascularization. It was evaluated whether physician preference contributes to this difference.
OBJECTIVES: To obtain information on how cardiac specialists manage male and female patients being evaluated for coronary artery disease.
METHODS: A computer-based patient simulation program was developed. Six sex-matched clinical vignettes (three pairs) with uninterpreted coronary angiograms were shown to specialists, who were blinded to the purpose of the study. The sex-matched scenarios were balanced with respect to symptoms, comorbidities and coronary anatomy. Physicians were surveyed on management and rationale.
RESULTS: Fifty physicians were surveyed, consisting mainly of cardiologists from tertiary cardiac centres in Ontario. Among the three sexmatched pairs, the frequencies at which percutaneous coronary intervention (including drug-eluting stents), bypass surgery and medical therapy were chosen did not differ across sexes. The means for men and women, respectively, were 47% and 50% for percutaneous coronary intervention, 32% and 26% for bypass surgery, and 21% and 24% for medical treatment.
CONCLUSIONS: In the present pilot study, cardiac specialists chose similar rates of medical, interventional and surgical procedures independent of a patient's sex. Although large registry trials show that sex differences in management exist, the present data suggest that cardiac specialist preference is less likely to be a factor if coronary angiography was performed. Further research is required to explore the causes of sex discrepancies in cardiac care.
Authors:
B M Meyers; T Vira; Chi- Ming Chow; B L Abramson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  25     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-09     Completed Date:  2009-12-01     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  649-53     Citation Subset:  IM    
Affiliation:
St Michael's Hospital, University of Toronto, Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / standards*,  trends
Attitude of Health Personnel
Cardiology / standards,  trends
Computer Simulation*
Confidence Intervals
Coronary Artery Bypass / standards*,  trends
Coronary Artery Disease / mortality*,  radiography,  therapy*
Female
Health Care Surveys
Hospitals, University
Humans
Male
Middle Aged
Ontario
Physician's Practice Patterns / standards,  trends
Pilot Projects
Probability
Quality of Health Care
Questionnaires
Risk Assessment
Severity of Illness Index
Sex Factors
Survival Analysis
Treatment Outcome
Comments/Corrections

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