Gender bias in the management and outcome of cardiovascular patients in Friuli Venezia Giulia (Northern Italy)

OBJECTIVE: to assess whether there are any differences depending on the patient's gender in the acute management of patients with symptoms compatible with coronary disease or admitted to the hospital with a diagnosis or coronary disease in the Friuli Venezia Giulia Region (Northern Italy). DESIGN: retrospective analysis of the Emergency Room (ER) and Hospitalization databases of the regional health information system. SETTING AND PARTICIPANTS: the study included all the patients who arrived at one of the 18 regional ERs because of chest pain, and all the patients admitted to one of the regional hospitals with a diagnosis of coronary disease in 2010. MAIN OUTCOME MEASURES: for both genders, waiting times from triage to the physician's visit, electrocardiogram (ECG) frequency in the ER among patients with chest pain and frequency of coronary angioplasty, and intrahospital mortality among patients admitted with a diagnosis of coronary disease were evaluated. RESULTS: women arriving at an ER with chest pain waited on average 3 minutes more than men before being visited by a physician (24.9 vs. 21.9 minutes); however, the likelihood of undergoing ECG was similar in the two genders (54.4% vs. 55.0%; OR: 0.96, 95% CI 0.89-1.03). Women admitted to the hospital because of coronary disease undergo coronary angioplasty less frequently than men (29.1% vs. 43.5%; OR: 0.67, 95% CI 0.57-0.78). Intrahospital mortality was 7.6% in men and 4.3% in women, however, it was similar after adjustment for confounders. Among patients <65 years it was 3 times higher for women than for men. CONCLUSION: some gender differences in the management of patients were observed. Further research is warranted to assess whether those differences reflect appropriate care or whether they indicate the existence of a gender bias affecting the decisions of healthcare professionals.