DIFFERENCES IN MANAGEMENT OF SUSPECTED MYOCARDIAL-INFARCTION IN MEN AND WOMEN

Background. Men and women with ischemic heart disease receive different medical treatment. Men receive more aggressive intervention and at an earlier stage of disease. However, differences in treatment between sexes have thus far been demonstrated only for invasive treatment, which may be less effective for women than for men. Methods. In a small community hospital, all patients admitted to the family practice service for suspected acute myocardial infarction from July 1988 to June 1989 were evaluated retrospectively to determine the reasons for placement in the cardiac care unit (CCU) vs regular nursing bed units with telemetry. The variables considered were patient age, patient sex, physician sex, and the likelihood of ischemia based on the Acute Ischemic Heart Disease Predictive Instrument (HDPI). Results. Ninety-three patients were entered in the study. The patient's age, sex, and likelihood of ischemia as measured by HDPI score were significantly related to probability of placement in the CCU. Women were less likely than men to be placed in the CCU, controlling for age and likelihood of ischemia (OR = 0.362, 95% CI = 0.135 to 0.977). Conclusion. Women appear to receive not only less intensive invasive treatment for ischemic heart disease than men, as previous studies have shown, but also less aggressive noninvasive treatment. This may represent unnecessary treatment of men rather than undertreatment of women. The findings of this study suggest, however, that physicians view women presenting with suspected acute myocardial infarction with less urgency than men presenting with similar symptoms.