Gender variation in clinical decision-making was measured, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD (Maserejian et al., 2009).
This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. The results: Physicians (n=128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age, but only among middle-aged women were they significantly less certain of the CHD diagnosis. Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts. An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain.
Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non- CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.
Innate differences in gender physiology result in unique exposures, risk, and protection that are specific to women. Recognition and appreciation of these differences results in better treatment adaptations for women and better outcomes. Disparities between genders in the treatment of major cardiovascular risk factors still exist and are mostly secondary to underestimating or misunderstanding a woman's risk. Preventive therapies are less often recommended to women. Women are more likely to be diagnosed and treated for hypertension, but are less likely to reach treatment goals. Through understanding these disparities, health care providers will be better able to screen female patients and institute evidence-based therapies for the prevention of cardiovascular disease (Jarvie & Foody, 2010).
Level of Evidence
Shirato and Swan, 2010
Nancy N. Maserejian, Carol L. Link, Karen L. Lutfey, Lisa D. Marceau, and John B. McKinlay, 2009
By Holli a. DeVon, RN, PhD, Catherine J. Ryan, RN, PhD, APRN, CCRN, Amy L. Ochs, BSN, and Moshe Shapiro, MS, 2008
Gisele S. Silva, Fabricio O. Lima, Erica C.S. Camargo, Wade S. Smith, Michael H. Lev, Gordon J. Harris, Elkan F. Halpern, Walter Koroshetz, and Karen L. Furie, 2010
Borejda Xhyheri and Raffaele Bugiardini, 2010
Vlassis N. Pyrgakis, 2010
Jerome Roncalli, Meyer Elbaza, Nicolas Dumonteila, Nicolas Boudoua, Olivier Laireza, Thibault Lhermusiera, Talia Chilona, Cecile Baixasa, Michel Galinier, Jacques Puela,, Jean-Marie Fauvela, Didier Carriea, Jean-Bernard Ruidavetsc, 2010
Chiara Melloni, Jeffrey S. Berger, Tracy Y. Wang, Funda Gunes, Amanda Stebbins, Karen S. Pieper, Rowena J. Dolor, Pamela S. Douglas, Daniel B. Mark, L. Kristin Newby, 2010
Chiara Melloni, Kristi Newby, 2009
Alice K. Jacobs, 2009
Ann F. Chou, Sarah Hudson Scholle, Carol S. Weisman, Arlene S. Bierman, Rosaly Correa-de-Araujo, and Lori Mosca 2007
Jennifer L. Jarvie & JoAnne M. Foody, 2010
Nina P. Paynter, Daniel I. Chasman, Guillaume Pare, Julie E. Buring, Nancy R. Cook, Joseph P. Miletich, and Paul M. Ridker, 2010
Krantz, M. Olson, J. Francis, C. Phankao, N.B. Merz, G. Sopko, D. Vido,
L.J. Shaw, D.S. Sheps, C. Pepine, K. Matthews and Wise Investigators, 2006
Main Points Scanned, Organized and Categorized
Multiple factors contribute to more cardiovascular complications in women. Women present atypical symptoms and are affected later in life relative to men.
Women relative to men have a greater risk of mortality from cardiovascular disease with respect to smoking, diabetes and hypertension and have been victims of inequity in the health system due to lack of data.
Case Control- Cohort Study
Gender disparities in cardiovascular disease may be due to innate features of female biology and lack of intervention in the health system.
Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities
Gender and age combinations mislead physicians particularly toward mental health diagnosis alternatives.
Randomized Clinical Trial
Regular use of low-dose aspirin may reduce the risk of MI in women.
Women are less likely to achieve independence after acute ischemic stroke.
Research suggests several gaps in knowledge related to the prevention of cardiovascular disease must be addressed to optimize the cardiovascular health of women.
Enrollment of women in randomized clinical trials has increased over time but remains low relative to their overall representation in disease populations. Efforts are needed to reach a level of representation that is adequate to ensure evidence-based sex-specific recommendations.
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Silva, Gisele, Fabricio O. Lima Erica C.S. Camargo…