Context Many studies indicate that women are less likely than men to underg
o cardiac procedures after an acute myocardial infarction (AMI), raising co
ncerns of sexual bias in clinical care. However, no data exist regarding th
e relationship between patient sex, physician sex, and use of cardiac proce
dures.
Objective To determine whether sex differences in cardiac catheterization a
fter AM] were greater when patients were treated by male attending physicia
ns compared with female attending physicians.
Design, Setting, and Patients Analysis of data from the Cooperative Cardiov
ascular Project, a retrospective medical record-review. A total of 104231 M
edicare fee-for-service beneficiaries who were hospitalized In US acute car
e hospitals for an AM] between January 1994 and February 1995.
Main Outcome Measure Use of cardiac catheterization within 60 days of admis
sion, compared between the 4 groups of patient sex-physician sex combinatio
ns.
Results Women underwent fewer cardiac catheterizations than men when treate
d by either male physicians (38.6% vs 50.8%; P=.001) or female physicians (
34.8% vs 45.8%; P=.001). Sex differences in procedure use were not greater
when a patient and physician were of different sexes (P for interaction =.8
5). After potential confounders in multivariable analysis were accounted fo
r, women were less likely to undergo cardiac catheterization (risk ratio, 0
.90 [95% confidence interval {CI}, 0.88-0.92]), regardless of the treating
physician's sex. Patients treated by male physicians were more likely to un
dergo cardiac catheterization (risk ratio, 1.06 [95% CI, 1.02-1.10]) than t
hose treated by female physicians, regardless of patient sex.
Conclusions Women who have had an AMI undergo a cardiac catheterization les
s often than men, whether treated by a male or female physician. These resu
lts suggest that factors other than sexual bias by male physicians toward w
omen account for sex differences in cardiac procedure use.