The Appropriateness of Use of Cardiovascular Procedures in Women and Men

A great deal of concern exists that women receive fewer revascularization procedures than men, and that this may represent discrimination against women. This article examines whether there are differences between men and women in the appropriateness of cardiovascular procedures (coronary angiography, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft surgery). The study was based on data obtained from a random sample of over 4,000 patients in 30 hospitals in New York State. Analyses were conducted using both the RAND appropriateness method and the Duke Prognostic Exercise Treadmill Score. The article concludes that the inappropriate use of cardiovascular procedures was low and not significantly different between men and women. In addition, the use of these procedures for uncertain or equivocal reasons 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. The analysis reported in this article is particularly strong and valid because the study uses two different methodologies to indicate that there may not be a gender bias in the use of these three cardiovascular procedures in hospital settings.