Men with symptoms of heart disease are 10 times more likely to be recommended for coronary bypass surgery than are women with similar symptoms, according to a new report.
The study, carried out among 390 patients treated in New York City between July 1982 and June 1983, found that even after accounting for differences in age and severity of disease, men were still considered for surgery almost seven times more often than women.
"It is an enormous, disturbing difference that cannot be explained by the distribution of heart disease in the population," said Jonathan Tobin, assistant professor of epidemiology at New York's Albert Einstein College of Medicine and principal author of the report. "Here is a case where social perceptions are masquerading as scientific fact. Unfortunately, sexism is just as common in medicine as it is everywhere else."
Tobin gave several reasons for the sex difference, including "my sense that doctors often make inaccurate assumptions about the relative contributions of men and women to society."
He said the purpose of the continuing five-year study is to find out when physicians are most likely to recommend bypass surgery, a costly procedure that has been peformed with increasing regularity over the past decade. He said the issue of sex bias emerged only after examining the data.
Heart disease is the nation's leading killer, striking men earlier than women, but affecting both sexes relatively equally, according to the National Center for Health Statistics (NCHS). In 1985, more than 230,000 coronary bypass operations were performed in U.S. hospitals, more than twice the 1980 figure. In both years, however, men received at least 70 percent of those operations.
According to the most recent statistics, more than 19 million Americans said they were told by doctors in 1985 that they had heart disease. Of those, 9 million were men and 10 million were women. The longer life expectancy of women accounted for their greater numbers, according to the NCHS.
Medical experts cite several reasons men receive most of the bypass operations. Patients with larger hearts and coronary arteries are more likely to respond well immediately after the surgery; men generally have larger coronary arteries than women. Also, because they are likely to live longer, women with serious heart disease are often older and sicker than men with the ailment.
Several studies have reported a higher mortality rate among women than men after bypass surgery. But at least one recent study has found no difference.
The authors of the new report found a widely held perception among doctors that the surgery simply is not as effective for women, a perception that does not appear to be well supported by data. Even so, the authors said they were surprised to see the massive differences in the percentages of men and women recommended for bypass surgery.
The study, published in Annals of Internal Medicine, found that women are twice as likely as men to have their symptoms -- such as chest pain and shortness of breath -- dismissed as something other than heart disease by their doctors.
There was also a significant difference in the reasons given by physicians for recommending further tests. With men, it was most likely to be an attempt to determine the severity of the illness. But with women, it was usually an effort to confirm the presence of disease.
"The same standard of care should apply to men and women, and they don't," said Dr. Richard Steingart, currently director of cardiology at Winthrop University Hospital in Mineola, N.Y., and co-author of the study. "At the very least we need better physician awareness and education."
The study analyzed how often patients were recommended for catheterization and coronary bypass surgery after having special tests that indicate heart disease.
Catheters are commonly used by surgeons to determine the presence and size of blocked areas in the arteries. They are inserted to the heart through the arm or groin and dye is released. The silhouette then indicates the ability of the heart to pump blood throughout the body.
In the study, only 4 percent of the women with strong initial signs of disease were recommended for catheterization, compared with 40 percent of the men.