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THE UTILIZATION OF CARDIOVASCULAR TESTING FOR THE INVESTIGATION OF WOMEN PRESENTING TO THE KINGSTON HEART

THE UTILIZATION OF CARDIOVASCULAR TESTING FOR THE INVESTIGATION OF WOMEN PRESENTING TO THE KINGSTON HEART CLINIC


Author Block: D Armstrong, A Johri, D Brouillard, M Matangi
Kingston, Ontario

Abstract:
INTRODUCTION: More women die of cardiovascular disease than men. A woman's healthcare provider and women themselves do not recognize this fact. Furthermore women are 12 times more likely to die from coronary heart disease and twice as likely to die from stroke than they are to die from breast cancer. With recent published guidelines indicating that women are not appropriately investigated for cardiovascular disease, we decided to analyze how women are investigated at the Kingston Heart Clinic in comparison to men.
METHODS: All data of patients presenting to the Kingston Heart Clinic are entered into a comprehensive cardiology database called CARDIOfile. Since June 1999 over 40,000 patients have had data entered. 18,902 men and 22,010 women (p<0.0001). We analyzed types of cardiovascular testing and diagnoses according to gender. All comparisons were analyzed using Chi-squared statistic.
RESULTS: See table 1. Not shown in the table because of space limitations is that women were more likely to have dobutamine and exercise stress echocardiography than men, (6449 vs 7229, p<0.0001). However this was offset by a much higher use of persantine and exercise myocardial perfusion imaging in men, (1434 vs 844, p<0.0001).
CONCLUSIONS: Despite the fact more women were enrolled in the clinic and that more women die of cardiovascular disease than men, women were much less likely to be investigated for cardiovascular disease and therefore less likely to be referred for either CABG or PCI. However, women were more likely to be labeled with a non-diagnosis such as chest pain or palpitations. The increased use of Holter and echocardiography in women seems likely to be related to these two non-diagnoses. Of importance 75% of our non-invasive testing is referred to the Kingston Heart Clinic by other physicians, primarily Family Physicians. Of these 75% approximately 80% are for an ACC/AHA class I indication and 15% are for an ACC/AHA class IIa indication. Changes have already been instituted to increase the use of all diagnostic cardiovascular testing in women.

Table 1
Test or diagnosis Men Women p value
Routine EST 7125 3883 <0.0001
Stress imaging 7883 8073 NS
Coronary angiogram 664 365 <0.0001
CAD diagnosis 1246 483 <0.0001
CABG or PCI 531 163 <0.0001
Echocardiography 8060 8908 <0.0001
Holter 1738 2056 <0.001
Chest pain or Palpitations 597 967 <0.01
Carotid IMT or ABI 548 235 <0.0001