The content of this website is intended for healthcare professionals only

Women more likely to survive heart attack if treated by female doctor

Gender inequality in heart attack mortality because 'most physicians are male'

Mark Gould

Tuesday, 07 August 2018

Female heart attack patients treated by male doctors have a worse chance of survival than those treated by female doctors, a study* suggests.

Using a census of 580,000 heart attack patients admitted to Florida hospitals between 1991 and 2010, researcher Dr Brad Greenwood, associate professor of information and decision sciences at the University of Minnesota, found higher mortality among female patients who are treated by male physicians.

Writing in Proceedings of the National Academy of Sciences Dr Greenwood found that male patients and female patients experience similar outcomes when treated by female physicians, suggesting that unique challenges arise when male physicians treat female patients.

The research further found that male physicians with more exposure to female patients and female physicians have more success treating female patients.

The team also found women were more likely to survive if the emergency department had a higher proportion of female doctors who had treated heart attacks – a trend particularly strong if the woman was being treated by a male doctor.

That, said Greenwood, could be because female doctors might share their experience in tackling heart attacks in women. In addition, the more female patients a male doctor had previously treated for heart attacks, the better the chances of survival a woman had.

“We find that gender concordance increases a patient’s probability of surviving a [heart attack] and that the effect is driven by increased mortality when male physicians treat female patients,” he said,

Previous studies based on data from Australia and Sweden have revealed that men and women experience different care if they have a heart attack, while UK research has shown women are more likely to be misdiagnosed.

As well as looking at the patients’ age, gender, and whether they had other health problems, the Minnesota team also looked at whether the patient died during their stay in hospital and whether the emergency room doctor primarily looking after them was a man or a woman. Overall, 11.9% of heart attack patients in the study died while in hospital.

However, the team found that when patients shared the same gender as their doctor, they were more likely to survive, with the probability of death falling by just over 0.6 percentage points once factors including the patients’ age, other health problems, the physician, and hospital-specific differences were taken into account.

Further analysis showed that men and women had similar chances of survival when they saw female doctors. But male doctors were linked to worse outcomes, particularly for women.

Female patients treated by male doctors were about 1.5 percentage points less likely to survive a heart attack than male patients in the care of female doctors.

“These results suggest a reason why gender inequality in heart attack mortality persists: most physicians are male, and male physicians appear to have trouble treating female patients,” the authors write. They suggest more female doctors are needed within emergency departments, and say training of doctors needs to be improved to make sure heart disease is not seen only as a male issue.

Greenwood speculated that there could be several reasons for the trend. “One could be that female patients are more comfortable advocating for themselves with a female physician,” he said. “[Or] it could be because women are more likely to present atypically and female physicians are better at picking up cues than their male colleagues.”

*Greenwood BN, Carnahan S, and Huang L. Patient–physician gender concordance and increased mortality among female heart attack patients. PNAS August 6, 2018. 201800097.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470