Sex differences in cardiac catheterization - The role of physician gender

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.