Women Die More From Heart Attacks Than Men -- Unless the ER Doc Is Female (scientificamerican.com)

Women who suffer from heart attacks may be at a higher risk of death in the emergency room if they see a male physician rather than a female one, a new study suggests. The study doesn't jump to conclusions, but doctors and cardiologists have a few theories. There could be a systematic bias where male physicians are not listening to female patients' complaints as readily as [those of] a man, or there could be a bias that favors men in the medical literature, leading to misdiagnoses in women. It may also be that female doctors do a better job than their male counterparts. "In the new study everyone was more likely to survive if they saw a female physician, and a study published last year [...] indicated all patients of female physicians had lower mortality and hospital readmission rates," reports Scientific American. From the report: Heart disease is the number-one killer of both men and women, but the latter are significantly less likely to survive heart attacks. According to 2016 American Heart Association statement, 26 percent of women will die within a year of a heart attack compared with just 19 percent of men. The gap widens with time: By five years after a heart attack almost half of women die, compared with 36 percent of men. The reason has eluded researchers for years, but the authors of the new study point to the disparity in male and female representation in emergency doctors as a potential source of answers. The researchers analyzed a Florida Agency for Health Care Administration database containing every heart attack case from every ER in the state (excluding Veterans Affairs hospitals) between 1991 and 2010.

The researchers divided 500,000-plus cases into four categories: male doctors treating men; male doctors treating women; female doctors treating men; and female doctors treating women. "All of those are statistically indistinguishable except for male doctor -- female patient," says Brad Greenwood, an author on the study and a data scientist at the University of Minnesota. If a heart attack patient is a woman and her emergency physician is a man, he says, her risk of death suddenly rises by about 12 percent. Put another way, a heart attack patient dies in the ER about 11.9 percent of the time overall -- but the research team found women with heart attacks will die about 12.4 percent of the time if their cases are handled by male doctors. This means approximately one out of every 66 women with heart attacks dies in the emergency room if she sees a male doctor rather than a female one.

Comments

So which is it?

[SlaveToTheGrind]

First proposition:

In the new study everyone was more likely to survive if they saw a female physician

Second proposition:

The researchers divided 500,000-plus cases into four categories: male doctors treating men; male doctors treating women; female doctors treating men; and female doctors treating women. " All of those are statistically indistinguishable except for male doctor -- female patient ," says Brad Greenwood, an author on the study

Since the second is apparently from an author, I'd tend to guess the first is "journalistic flair" (ahem) from someone carrying around a gender hammer. Unfortunately can't look at the study itself to confirm -- the link in TFS is actually to the AHA 2016 statement and the actual study is paywalled.

Re:So which is it?

[guruevi]

I can get to it since I have subscriptions to these journals:

If you want better P-values, the significance halves. The reporting was done on the raw data which shows a slight variation within the error bars. Even if the study is correct, it comes down that statistically speaking, 2 out of the 500,000 cases may have survived longer if they had a female doctor.

Re:Maybe doctors don't want to go to jail

[Antique Geekmeister]

CPR is not used for mycoardial infarction. The heart stopping, such as from atrial tachycardia, is treatable with CPU. CPR is quite dangerous, it tends to break ribs and is not that efficient. The mortality rate for CPR is also quite high: if you ever perform CPR in the field, it's important not to blame yourself personally if it fails, even if you made small mistakes. Only roughly 1/3 of CPR patients survive.

Myocardial Infarctions are tissue death in the heart, caused by a blockage. They're typically painful because muscle tissue in the heart is _dying_. Many people have survived numerous small infarctions. ECG's, however, electro cardiograms, where electrodes are placed on the chest and a few elsewhere on the body to monitor heart activity, does involve at least opening up the shirt and exposing the chest.

Also, many patients are quite frightened in the emergency room. I can easily picture a frightened, older female patient, who grew up more than 50 years ago, being less frightened and less reluctant to share their full medical information with a male physician, and their family or caregivers less able to communicate with a male physician.

Re:Bring on the robots?

[AmiMoJo]

The study concludes:

"Sex differences occur in the pathophysiology and clinical pre-sentation of MI and affect treatment delays. Recommended perfusion therapies for AMI in women are similar to those in men, yet bleeding risks and other complications remain greater in women. Women are undertreated with guideline-based recommendations, leading to worse outcomes and increased rates of readmission, reinfarction, and deaths in the first year after MI."

So it seems like some doctors are failing to diagnose the issue as quickly in women as they do in men, because of the different ways that the condition presents. Furthermore they undertreat women.

Also,

"To further compound undertreatment, womenâ(TM)s adherence to these evidence-based recommendations is sub-optimal. There is a need for continued public health messages and interventions to target racial and ethnic minority women"

So when they are treated women from certain backgrounds are somewhat less likely to stick to the treatments. I kind of wonder if cost is a factor there.

The difference in outcomes between male and female doctors treating women is statistically significant but small in comparison to these bigger issues.

Re: Could it possibly be age?

[AmiMoJo]

It's in the conclusion section of TFP.