THE APPROPRIATENESS OF USE OF CARDIOVASCULAR PROCEDURES IN WOMEN AND MEN

Objective: To determine whether there are differences between women an d men in the appropriateness of use of cardiovascular procedures. Desi gn: Retrospective chart review. Setting: Thirty hospitals located in N ew York State. Patients: Random sample of 3979 patients undergoing cor onary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery in 1990. Measures: We evaluated t wo measures: (1) the percent of women and men who underwent cardiovasc ular procedures for appropriate, uncertain, and inappropriate indicati ons and (2) for coronary angiography patients, the prognostic exercise stress treadmill score that predicts before the coronary angiogram th e 5-year probability of death from a cardiovascular event. Results: Th e inappropriate rate of use of cardiovascular procedures was low and n ot significantly different for men and women (4% vs 5% for coronary an giography; 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 v ary significantly by gender. There was also no significant gender diff erence in the predicted risk of death from a cardiovascular event for coronary angiography patients: 24% of men and 22% of women were at hig h risk tie, <75% 5-year survival rate) and 20% and 16%, respectively, were at low risk tie, greater than or equal to 95% 5-year survival rat e). Conclusion: Based on two indicators, the RAND appropriateness scor e and the Duke prognostic exercise treadmill score, we were unable to find any evidence of a difference in the clinical appropriateness of u se of these three cardiovascular procedures between women and men.