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December 12, 1994

The Appropriateness of Use of Cardiovascular Procedures in Women and Men

Author Affiliations

From the Schools of Medicine and Public Health, University of Michigan, Ann Arbor (Dr Bernstein); the RAND Corporation, Santa Monica, Calif (Drs Bernstein, Hilborne, Leape, Park, and Brook); the Schools of Medicine (Drs Hilborne and Brook) and Public Health (Dr Brook), University of California—Los Angeles; and the Harvard School of Public Health, Boston, Mass (Dr Leape).

Arch Intern Med. 1994;154(23):2759-2765. doi:10.1001/archinte.1994.00420230156019

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)

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