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The Appropriateness of Use of Cardiovascular Procedures in Women and Men

The Appropriateness of Use of Cardiovascular Procedures in Women and Men Abstract Objective: To determine whether there are differences between women and men in the appropriateness of use of cardiovascular procedures. Design: Retrospective chart review. Setting: Thirty hospitals located in New York State. Patients: Random sample of 3979 patients undergoing coronary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery in 1990. Measures: We evaluated two measures: (1) the percent of women and men who underwent cardiovascular procedures for appropriate, uncertain, and inappropriate indications and (2) for coronary angiography patients, the prognostic exercise stress treadmill score that predicts before the coronary angiogram the 5-year probability of death from a cardiovascular event. Results: The inappropriate rate of use of cardiovascular procedures was low and not significantly different for men and women (4% vs 5% for coronary angiography; 4% vs 3% for percutaneous transluminal coronary angioplasty; and 2% vs 3% for coronary artery bypass graft surgery, respectively), and the use of these procedures for uncertain reasons also did not vary significantly by gender. There was also no significant gender difference in the predicted risk of death from a cardiovascular event for coronary angiography patients: 24% of men and 22% of women were at high risk (ie, <75% 5-year survival rate) and 20% and 16%, respectively, were at low risk (ie, ≥95% 5-year survival rate). Conclusion: Based on two indicators, the RAND appropriateness score and the Duke prognostic exercise treadmill score, we were unable to find any evidence of a difference in the clinical appropriateness of use of these three cardiovascular procedures between women and men.(Arch Intern Med. 1994;154:2759-2765) References 1. Tobin JN, Wasserthiel-Smoller S, Wexler JP, et al. Sex bias in considering coronary bypass surgery . Ann Intern Med. 1987;107:19-25.Crossref 2. Steingart RM, Packer M, Hamm P, et al. Sex differences in the management of coronary artery disease . N Engl J Med. 1991;325:226-230.Crossref 3. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary artery disease . N Engl J Med. 1991;325: 221-225.Crossref 4. Krumholz HM, Douglas PS, Lauer MS, Pasternak RC. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for gender bias? Ann Intern Med. 1992;116:785-790.Crossref 5. Bickell NA, Pieper KS, Lee KL, et al. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992; 116:791-797.Crossref 6. Laskey WK. Gender differences in the management of coronary artery disease: bias or good clinical judgment? Ann Intern Med. 1992;116:869-870.Crossref 7. Leape LL, Hilborne LH, Park RE, et al. Appropriateness of the use of coronary artery bypass graft surgery in New York State . JAMA . 1993;269:753-760.Crossref 8. Hilborne LH, Leape LL, Bernstein SJ, et al. The appropriateness of the use of percutaneous transluminal coronary angioplasty . JAMA . 1993;269:761-765.Crossref 9. Bernstein SJ, Hilborne LH, Leape LL, et al. The appropriateness of use of coronary angiography . JAMA . 1993;269:766-769.Crossref 10. Bernstein SJ, Laouri M, Hilborne LH, et al. Coronary Angiography: a Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: The RAND Corp; 1992. 11. Hilborne LH, Leape LL, Kahan JP, Park RE, Kamberg CJ, Brook RH. Percutaneous Transluminal Coronary Angioplasty: A Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: RAND; 1992. 12. Leape LL, Hilborne LH, Kahan JP, et al. Coronary Artery Bypass Graft: A Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: RAND; 1992. 13. Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease . Ann Intern Med. 1987;106:793-800.Crossref 14. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease . N Engl J Med. 1991;325:849-853.Crossref 15. Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons Inc; 1977. 16. Kish L. Survey Sampling . New York, NY: John Wiley & Sons Inc; 1965. 17. Huber PJ. The behavior of maximum likelihood estimates under non-standard conditions . In: Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability . Berkeley, Calif: University California Press; 1967: 221-233. 18. National Center for Health Statistics. Advance Report of Final Mortality Statistics, 1990 . Hyattsville, Md: Public Health Service; 1993;41( (suppl) ):30. 19. Isles CG, Hole DJ, Hawthorne VC, Lever AF. Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men . Lancet . 1992;339:702-706.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Appropriateness of Use of Cardiovascular Procedures in Women and Men

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420230156019
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine whether there are differences between women and men in the appropriateness of use of cardiovascular procedures. Design: Retrospective chart review. Setting: Thirty hospitals located in New York State. Patients: Random sample of 3979 patients undergoing coronary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery in 1990. Measures: We evaluated two measures: (1) the percent of women and men who underwent cardiovascular procedures for appropriate, uncertain, and inappropriate indications and (2) for coronary angiography patients, the prognostic exercise stress treadmill score that predicts before the coronary angiogram the 5-year probability of death from a cardiovascular event. Results: The inappropriate rate of use of cardiovascular procedures was low and not significantly different for men and women (4% vs 5% for coronary angiography; 4% vs 3% for percutaneous transluminal coronary angioplasty; and 2% vs 3% for coronary artery bypass graft surgery, respectively), and the use of these procedures for uncertain reasons also did not vary significantly by gender. There was also no significant gender difference in the predicted risk of death from a cardiovascular event for coronary angiography patients: 24% of men and 22% of women were at high risk (ie, <75% 5-year survival rate) and 20% and 16%, respectively, were at low risk (ie, ≥95% 5-year survival rate). Conclusion: Based on two indicators, the RAND appropriateness score and the Duke prognostic exercise treadmill score, we were unable to find any evidence of a difference in the clinical appropriateness of use of these three cardiovascular procedures between women and men.(Arch Intern Med. 1994;154:2759-2765) References 1. Tobin JN, Wasserthiel-Smoller S, Wexler JP, et al. Sex bias in considering coronary bypass surgery . Ann Intern Med. 1987;107:19-25.Crossref 2. Steingart RM, Packer M, Hamm P, et al. Sex differences in the management of coronary artery disease . N Engl J Med. 1991;325:226-230.Crossref 3. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary artery disease . N Engl J Med. 1991;325: 221-225.Crossref 4. Krumholz HM, Douglas PS, Lauer MS, Pasternak RC. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for gender bias? Ann Intern Med. 1992;116:785-790.Crossref 5. Bickell NA, Pieper KS, Lee KL, et al. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992; 116:791-797.Crossref 6. Laskey WK. Gender differences in the management of coronary artery disease: bias or good clinical judgment? Ann Intern Med. 1992;116:869-870.Crossref 7. Leape LL, Hilborne LH, Park RE, et al. Appropriateness of the use of coronary artery bypass graft surgery in New York State . JAMA . 1993;269:753-760.Crossref 8. Hilborne LH, Leape LL, Bernstein SJ, et al. The appropriateness of the use of percutaneous transluminal coronary angioplasty . JAMA . 1993;269:761-765.Crossref 9. Bernstein SJ, Hilborne LH, Leape LL, et al. The appropriateness of use of coronary angiography . JAMA . 1993;269:766-769.Crossref 10. Bernstein SJ, Laouri M, Hilborne LH, et al. Coronary Angiography: a Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: The RAND Corp; 1992. 11. Hilborne LH, Leape LL, Kahan JP, Park RE, Kamberg CJ, Brook RH. Percutaneous Transluminal Coronary Angioplasty: A Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: RAND; 1992. 12. Leape LL, Hilborne LH, Kahan JP, et al. Coronary Artery Bypass Graft: A Literature Review and Ratings of Appropriateness and Necessity . Santa Monica, Calif: RAND; 1992. 13. Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease . Ann Intern Med. 1987;106:793-800.Crossref 14. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease . N Engl J Med. 1991;325:849-853.Crossref 15. Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons Inc; 1977. 16. Kish L. Survey Sampling . New York, NY: John Wiley & Sons Inc; 1965. 17. Huber PJ. The behavior of maximum likelihood estimates under non-standard conditions . In: Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability . Berkeley, Calif: University California Press; 1967: 221-233. 18. National Center for Health Statistics. Advance Report of Final Mortality Statistics, 1990 . Hyattsville, Md: Public Health Service; 1993;41( (suppl) ):30. 19. Isles CG, Hole DJ, Hawthorne VC, Lever AF. Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men . Lancet . 1992;339:702-706.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 12, 1994

References