Heart Disease Primary Care In England Biased Towards Men

Primary care for patients with heart disease in England is systematically biased towards men even though there is no indication of deliberate differences in the management of men and women within the health care system.

In a cross-section survey, Dr. Julia Hippisley-Cox, and colleagues at the Department of Primary Care, Nottingham University, Nottingham, England, surveyed 2,808 men and 2,793 women from 18 practices in 18 primary care groups in the Nottingham region. Patients were over the age of 35 and had been diagnosed with ischaemic heart disease or been prescribed nitrates.

Investigators found that women were less likely than men to have a recording of body mass index, smoking, and blood pressure. Women were also less likely to have a recording of fasting cholesterol concentration but were more likely to be obese and have their most recently recorded blood pressure value over the recommended 140/85 mm Hg.

Although a higher proportion of women had a raised serum cholesterol concentration, men were more likely to take aspirin, have a recorded diagnosis of hyperlipidaemia , and be prescribed lipid lowering drugs. These differences remained despite adjustments for the practice where the patient is registered, age, smoking status, obesity, diabetes, and hypertension.

The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease.

Investigators identified the target population from the practices’ computer systems and were not able to validate the diagnoses of ischaemic heart disease by reference to manual records and previous investigations (for example, exercise electrocardiography, angiography). However, validations done in previous studies show that important discrepancies are unlikely.

“In addition, we performed a subgroup analysis on patients with more severe ischaemic heart disease (defined as those with a myocardial infarction or taking more than one antianginal drug), and our findings remained unchanged,” they add.

Dr. Hippisley-Cox and colleagues conclude: “The differences we detected are likely to be not only significant but clinically important.”

BMJ 2001;322;832-834.