SOCIAL JUSTICE – CARDIOLOGY

A fifty-five-year-old woman complains that her husband is getting better care than she is for her coronary artery disease. They both have angina. She noted that her husband received a stress test, cardiac catheterization, and stent placement within three days after complaining of chest pain. She received the same treatment over a month period and only after she had repeatedly complained of chest pain to her internist.

A Perspective from a Cardiologist

Clinical Background

While women are more likely to die from heart disease than any other cause, diagnostic approaches to their chest pain are often less aggressive than those for men. Twenty years ago it was reported that 40 percent of male patients with abnormal exercise radionuclide scans were referred for cardiac catheterization whereas only 4 percent of female patients were referred for testing. In an analysis of patients who were entered in the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial, a study of patients treated for acute coronary syndrome, women were found to be less likely than men to receive coronary angiography (25.4 percent vs. 29.5 percent). These genderrelated differences in care are not limited to the United States.