Male family physicians, or general practitioners, may be overlooking the risk of cardiovascular disease in female patient because they more often see it as a man’s issue, according to new research published in the European Journal of Preventive Cardiology.
Heart disease is a leading cause of death in the United States.
Since the 1980s, developed countries have seen a fall in the number of deaths from cardiovascular disease (CVD). Around 50 percent of this improvement is thought to be because of preventive action.
In men, the rates of mortality from CVD have dropped more than they have in women. There is also evidence that men receive better cardiovascular care after experiencing a cardiovascular problem, as well as better secondary prevention.
Dr. Raphaëlle Delpech, a general practitioner (GP) at Paris XI University and INSERM U1018 in Paris, France, and colleagues hypothesized that men might also be receiving better primary care than women.
Primary prevention starts with an assessment of a patient’s risk factors.
The team looked at 52 primary care physicians and 2,262 patients. They wanted to know whether the gender of the physician and the patient would make a difference to the risk assessment.
- In 2013,
611,105people died of heart disease in the U.S.
- This represents 23.5 percent of all deaths
- There were 1.6 male deaths from heart disease for every female.
The physicians and patients provided information about personal details in a survey.
Information provided by the physicians included their age, gender, and working hours. Patients also answered questions about their educational level and health insurance.
Using medical files, the team gathered information about patients’ gender, age, any history of diabetes, and CVD risk factors. These included a personal and family history of CVD, tobacco use, fasting blood glucose, blood pressure, and cholesterol.
To calculate the risk of CVD, the details of a patient’s risk factors can be applied to an existing, validated scale.
The team used two scales, the French scale and the SCORE scale.
The French scale classifies the risk of CVD as low, moderate, or high, depending on the number of risk factors that the patient has.
The SCORE scale uses the patient’s risk factors to predict the likelihood of them experiencing a cardiovascular event within the next 10 years.
The researchers wanted to know if there was enough information about the patients of both genders to use the scales accurately.
For female patients, they found that there was often not enough information in the medical files kept by the physicians to be able to use the scales. On the French scale, female patients could be accurately evaluated 36 percent less often than males, and on the SCORE scale, 37 percent less often.
Dr. Delpech notes that physicians were less likely to gather details from female patients about smoking, cholesterol, and blood glucose. As a result, she says, they are unable to evaluate the cardiovascular risk.
The team compared results for male and female physicians. They found that when a female patient was seen by a female doctor, there was 28 percent less chance of there being enough data for assessment on the SCORE scale. If the doctor was a man, the chance was 44 percent lower, compared with male patients.
“Guidelines recommend screening for cardiovascular risk factors in men and women, but it appears that GPs are more attentive to these factors in their male patients. This could be because CVD is more frequent among men, who have historically been more likely to adopt risky habits like smoking.”
Dr. Raphaëlle Delpech
She added: “The patients who were least well assessed for cardiovascular risk were women seen by male GPs. We think that female GPs follow guidelines more routinely and are less likely to vary their practice, especially according to their patients’ gender.”
The authors expect physicians to be surprised at the results, and they hope the findings will help them to assess male and female patients more equally.
They suggest a government media campaign to raise awareness and prompt change, or perhaps an introduction of performance-related pay that would benefit those professionals who fully assess patients’ cardiovascular risk.
Dr. Delpech concludes that a better assessment of risk could be a step toward reducing mortality from CVD in both men and women.