In a Shift, Women Referred More Often for Cardiac Catheterization after Noninvasive Testing By Wayne Kuznar
n an apparent dramatic shift in practice patterns, women are twice as likely as men to be referred for cardiac catheterization to diagnose obstructive coronary artery disease (CAD), according to an examination of data from a large registry presented at ACC.10. Catheterization has historically been performed much more frequently in men, but the new data imply that widespread public awareness campaigns about women and cardiovascular disease (CVD) have been successful at educating physicians and altering their behavior, said lead investigator Marcelo Di Carli, MD, Director of the Noninvasive Cardiovascular Imaging Program at Brigham and Women’s Hospital, Boston.
ateness for referral to cardiac catheterization in patients after noninvasive testing, it is unclear whether the observed variation in referral to cath-
eterization reflects undertreatment, appropriate use, or overtreatment,” said Dr Di Carli. Numerous previous studies have
found undertreatment of stable CVD in women compared with men, he said, and “it seems that the pendulum has swung in the opposite direction.” ■
“Without a definitive standard of appropriateness for referral to cardiac catheterization in patients after noninvasive testing, it is unclear whether the observed variation in referral to catheterization reflects undertreatment, appropriate use, or overtreatment.” —Marcelo Di Carli, MD The registry included 1703 patients (891 women and 812 men) with an intermediate-to-high likelihood of CAD who underwent various cardiac imaging tests (ie, SPECT, positron emission tomography, and coronary computed tomography angiography). The researchers assessed the 90-day referral to cardiac catheterization in these patients. They found that 13% of women versus 6% of men were referred to cardiac catheterization. After adjustment for age, diabetes, noninvasive imaging studies, and chest pain, female sex remained a significant predictor of referral to cardiac catheterization. Whether the observed difference in this study is a result of excessive referral to cardiac catheterization in women or underutilization in men requires further investigation. “Without a definitive standard of appropriSEE ALSO “Less-Intensive Treatment Post-MI in Women…” on page 14.
AMERICAN HEALTH & DRUG BENEFITS
American College of Cardiology ACC 2010: Payer's Perspectives