Gender bias in treatment for coronary heart disease: fact or fallacy?

摘要

It seems clear that applying terms such as 'bias' and 'discrimination' to the lower levels of investigation and treatment of women with coronary heart disease is, on current evidence, premature. As has been pointed out before, routine administrative databases or even information collected from clinical trials has limited usefulness in enlightening the underlying judgement processes in cardiology, and in contrast to some recently expressed views they should not be used to assess how equitably services have been provided. The majority of studies seem to suggest that once angiography is performed, men and women are treated equitably. Even though inequality has been demonstrated, any claims that this lends support to an hypothesis of discrimination are made no more likely by the attainment of statistical 'significance' for the differences in revascu-larization rates. Perhaps more research should be undertaken into differences in symptom management and how clinicians weight different clinical cues. The capacity to benefit from cardiac surgery depends on a variety of factors, including symptom severity, ejection fraction and angiographic disease severity. The apparent disparity in the treatment of men and women may arise from the varying weight placed on these 'cues'.