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Medicine Science

Women Die More From Heart Attacks Than Men -- Unless the ER Doc Is Female (scientificamerican.com) 275

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.

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Women Die More From Heart Attacks Than Men -- Unless the ER Doc Is Female

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  • by Anonymous Coward on Wednesday August 08, 2018 @06:06AM (#57090388)

    Same way men will lie about their problems so as not to appear lesser. Nothing says women don't have pride.

    • by arth1 ( 260657 ) on Wednesday August 08, 2018 @07:44AM (#57090638) Homepage Journal

      I'm not sure that's the cause. The study also shows that male doctors with more experience with female patients have a better outcome than male doctors with less experience with female patients.
      There are things women and men might lie about or unconsciously "adjust" in different ways. If you had a non-obese patient, the male might claim he weighs a little more than he does, and a woman might claim she weighs a little less than she does. But in a hospital setting, I'm sure they do actual measurements instead of relying on the patient.

      But you may have touched upon a potential factor here: communication. It may be, for example, that female patients are less good at volunteering the important information, and that female doctors and male doctors with experience treating females have less problems communicating in a way where the female patient tells important things. Which may include things that a female patient may be uncomfortable disclosing to a young male, like also having an UTI, yeast infection, irregular periods or copper implant. And a younger male doctor may be more uncomfortable with and less good at getting this information, perhaps expecting "any other problems?" to cover that. A doctor that's experienced with either being a women or treating female patients may just be better at asking direct questions.

      • I remember reading somewhere that some conditions - particularly heart attacks - present differently between men and women. We typically think of chest pain and burning around the upper-left chest and shoulder area with a heart attack. Symptoms in women [heart.org] are often that and more - they might experience jaw/back pain, nausea and shortness of breath. Things that could be confused with a common cold or flu pretty easily.

        It's the docs job to know the symptoms and correlate, they can't help much if they don't know

      • Actually it's much simpler than that.
        Their claim that their groups seperate out other infractions is not even basically correct.
        All it takes is two biases.
        For example if women having attacks are more likely to die (which they are add women tend to have them later in life) and male doctors are more likely to be given more difficult cases (which they are, as they tend to be more senior due to a longer time in the system) then we would see exactly this distribution.

        How on earth a statistical paper can be publi

    • This effect is probably on the doctor side, not the patient side. There is emerging evidence that female surgeons have better outcomes than male surgeons, for operations done on either gender.
      • by igny ( 716218 )
        The effect is probably on the statistician side. If you keep conducting studies trying to correlate some events with gender, you will get 1 study per 20 that "confirms" with confidence level of 95% that gender has effect on some of the events.
    • I would word it more to the fact that the dynamic between same gender doctors vs different gender doctors may be an issue.
      The difference may more be in the interaction vs the differences between different genders.

      A Male with a Male doctor will be more honest with pain levels and explaining the issues. vs with a Male Patient with a Female doctor who may instinctive want to appear tougher then he really feels.

      Normally when a man goes into a hospital they actually get extra attention because they will often go

    • I'd be more inclined to look at the different motivations for male and female doctors.

      Men are motivated to become doctors because it is a highly prestigious profession, they are also more likely to choose to become specialist in something like surgery.

      Female doctors are much more likely to be motivated by compassionate and empathic reasons, the also more like to become general practitioners.

      This is going lead to different levels of experience and skill in communication and diagnostics.

  • by Anonymous Coward on Wednesday August 08, 2018 @06:12AM (#57090398)

    Have all doctors identify as women and all patients identify as men.

  • by Anonymous Coward on Wednesday August 08, 2018 @06:15AM (#57090410)

    From the abstract: "We further find that male physicians with more exposure to female patients and female physicians have more success treating female patients."
    http://www.pnas.org/content/early/2018/07/31/1800097115

    Just seems like people with more experience in treating females are better at treating females.

  • by SCVonSteroids ( 2816091 ) on Wednesday August 08, 2018 @06:23AM (#57090426)

    No? The TFS sure as hell does!

    • Perhaps you would like to clarify, what conclusion does the TFS makes.
    • The only conclusion that anyone is drawing anywhere here on this page right now is the following: I conclude that SCVonSteroids doesn't understand what the word "conclusion" means.

      • It's possible. English is not my native language, but please do educate me.

        A summary is this, no? -> "Women Die More From Heart Attacks Than Men -- Unless the ER Doc Is Female"
        A conclusion is what you determine based on your research, no? -> "Women Die More From Heart Attacks Than Men -- Unless the ER Doc Is Female"

        Is the summary not the clickbait sentence that gets us to the article page?
        I'll be happy to admit I'm wrong if I am, but fucking hell I'm pretty sure you're just being nit picky twits. My p

        • First, "study" means the published research paper, not the news article ("story") describing it.

          In this context, "jump to conclusions" means "stating a cause". While some article writers and other doctors not involved in the study will gladly speculate on possible causes for the statistical difference, the study itself doesn't do so.
  • by Opportunist ( 166417 ) on Wednesday August 08, 2018 @06:25AM (#57090438)

    (from the referenced paper in the article [ahajournals.org], page 918 left side):

    Women are often older when they present with their first AMI, at an average age of 71.8 years compared with 65 years for men.

    (with AMI meaning Acute Myocardial Infarction)

    Now, could it be that the shorter long term survival rate has more to do with age than gender?

    Also, there is a very interesting graph on the previous page depicting the AMI-related deaths for both sexes, with female deaths due to cardiovascular faults being in sharp decline since 2000. So either something happened around that time that made women less susceptible to dying from a heart attack, or something else took over as the big lady killer.

    • by phantomfive ( 622387 ) on Wednesday August 08, 2018 @06:33AM (#57090454) Journal
      It seems like if it were due to age, then the effect wouldn't disappear when female doctors were treating them.
      • by AmiMoJo ( 196126 )

        The main issue seems to be that although there are effective treatments they are underprescribed for women.

        • Then I guess we should examine why.

        • The main issue seems to be that although there are effective treatments they are underprescribed for women.

          Why do you think this? Is there a citation?

          • Re: (Score:2, Informative)

            by AmiMoJo ( 196126 )

            It's in the conclusion section of TFP.

            • Oh yeah, here it is:

              "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. CR is underused and underprescribed for women, but novel approaches to increase participation by women are promising. To further compound undertreatment, women’s adherence to these evidence-based recommendations is sub- optimal."

    • Comment removed based on user account deletion
    • It could be age related, in that the age profiles of male/female doctors are different, and there is a larger ratio of male doctors in their declining years making more "old person" mistakes than the women.

      But my pet theory is that women are better doctors.

    • Also, there is a very interesting graph on the previous page depicting the AMI-related deaths for both sexes, with female deaths due to cardiovascular faults being in sharp decline since 2000. So either something happened around that time that made women less susceptible to dying from a heart attack, or something else took over as the big lady killer.

      Here is the same graph (not divided by gender, though) [heart.org]. The trend increases and decreases, To some degree matching cigarette consumption [medium.com] over the same period. Of course medical care has improved also over that time. Male cigarette smokers dropped more sooner, and farther, than women. There were more male smokers, too, so they had farther to drop. Currently rates between the two are the same.

      The link between cigarettes and heart disease doesn't explain everything but it does explain a lot.

  • for women to have fewer heart attacks, like they did when they stayed home, kept house and raised the kids.

  • So which is it? (Score:5, Informative)

    by SlaveToTheGrind ( 546262 ) on Wednesday August 08, 2018 @06:33AM (#57090452)

    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.

    • by Entrope ( 68843 )

      Yeah, I was hoping to see the actual confidence ranges that gave rise to the study author's conclusion. Was there much overlap in the "statistically indistinguishable" cases, or barely any? How much separation was there between those cases and the one that was distinguished? Did they appropriately adjust their idea of statistical significance for testing however many hypotheses they considered, or did they go trawling for p-values?

    • Re:So which is it? (Score:5, Informative)

      by guruevi ( 827432 ) on Wednesday August 08, 2018 @09:18AM (#57090990)

      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.

  • But I guess we'll have to make sure that they're not learning from predominantly male diagnosticians.

    • by AmiMoJo ( 196126 ) on Wednesday August 08, 2018 @08:14AM (#57090728) Homepage Journal

      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.

  • The third hypothesis should be easily testable as you can look at success rate across all surgeries based on sex of patient and doctor. It could well be that female surgeons have better success rates across all patients, though a weirder finding would be success rate correlated to similarly between sex of the patient and doctor.

    The second seems more likely to me from my own perspective as I know that that symptoms of a heart attack present differently in males and females. But I expect medical profession
  • by esperto ( 3521901 ) on Wednesday August 08, 2018 @07:12AM (#57090556)
    Read most of the paper and the SciAm article, and I have two critiques, one for the paper and one for SciAm:
    For the paper what seem to have happen is two fold.

    First they had an open question, wanted to see if patients had different outcomes from male and female doctors, this is a prime example on how to poke the data until something came out, you just look at every combination until something presents a statistical significant value, I bet that if they do this study again they will get different findings.
    Second, the difference was not that big, 0,5% less on the outcome of both cases, mortality and readmission, (or about 4% in relative terms) when treated by a woman, when the biggest difference in outcome, according the numbers by SciAm, was the gender itself, 26% of women will die within a year of a heart attack compared with 19% of men.

    The researches say they adjusted for several factors, but I wonder if differences in choices of time or location of work between men and women may cause the difference, if it is actually real.
    And by the way, the mean age of patients in the study is 80 years old, and almost 2/3 were women.

    For the SciAm article, they seem to not report on the paper, but on part of the raw data in the paper, which is likely not adjusted for confounding factors and the report also seem very biased and sensationalist.

    • Second, the difference was not that big, 0,5% less on the outcome of both cases, mortality and readmission, (or about 4% in relative terms) when treated by a woman, when the biggest difference in outcome, according the numbers by SciAm, was the gender itself, 26% of women will die within a year of a heart attack compared with 19% of men.

      This. The difference is very small. If you're in the ER for a heart attack, you should be seen by a doctor - male or female - immediately. Time is of the essence. The sensat

    • Comment removed based on user account deletion
  • by blindseer ( 891256 ) <blindseer.earthlink@net> on Wednesday August 08, 2018 @07:23AM (#57090586)

    Just remove this meaningless social construct that is gender from the study and the problem goes away.

  • https://xkcd.com/882/ [xkcd.com]

    I need to say this: despite the fact that misoginy is a real problem in our society, this is just a spurious correlation.

  • by ooloorie ( 4394035 ) on Wednesday August 08, 2018 @09:04AM (#57090932)

    There could be a systematic bias where male physicians are not listening to female patients' complaints as readily as [those of] a man,

    How about:

    (1) male physicians are bigger risk takers and take on harder cases

    (2) male physicians are taking a longer view picture and don't waste resources on patients that may not die in the emergency room but will die within a few days

    (3) male physicians do, in fact, listen more to their patients, about 20% of whom have do not resuscitate orders, and more who may express a verbal preference against extraordinary measures or a life with severe mental disability

    (4) there are differences in reporting between male and female physicians

    • oh, and perhaps the most important one (related to 1):

      (5) male and female physicians choose different work environments and see different patient populations

    • How about them?

      Do you have any evidence or are you just JAQing off?

      • How about them? Do you have any evidence

        No, I don't have any evidence. My points are called "alternative hypotheses". Actual scientists understand that proposing alternative hypotheses is a key element of how science makes progress.

    • Do any of those explanations account for the lack of statistical difference between male and female doctors when the patient is male?
      • Do any of those explanations account for the lack of statistical difference between male and female doctors when the patient is male?

        Your question shows a fundamental misunderstanding of "lack of statistical[ly significant] difference". A lack of statistically significant difference doesn't mean "evidence of absence" it means "absence of evidence".

        • Okay, I'll rephrase. How do your explanations account for the statistical difference between male and female doctors when the patient is female in a way that wouldn't equally apply when the patient is male?
          • There is nothing to account for. You cannot conclude anything from the absence of statistical significance. So we don't know which of these differences are real and which ones are not, hence it's pointless to speculate which of the alternative hypotheses I listed applies. Women treating men may have the same statistical differences as women treating women, but they didn't show up.

            But let's say we actually knew all the differences for certain. Every possible pattern of differences could simply be explained i

  • What was not usable from the Veterans Affairs data sets?
  • by rickb928 ( 945187 ) on Wednesday August 08, 2018 @10:06AM (#57091240) Homepage Journal

    A partner of mine suffered from agoraphobia terribly, sometimes suffering anxiety and tachycardia with HR over 220 for extended periods. Counseling, medication, nothing seemed to be effective, and she was a highly-skilled RN, just adding to her frustration. It ruined our relationship long before it became so debilitating she was considering changing her career.

    One attack landed her in the ER and in front of the new-in-town cardiologist fresh from residency in a well-known hospital. According to the ER nurse he took a two minute look at the EKG, ordered tests stat, another two minute read, and was on the phone back to his residency hospital, booking air evac, and sending her to his mentor.

    She had a conduction defect. Not merely undetected for her entire life, but actually ruled out by more than one cardiologist previously, certain she was just having panic attacks. Yes, this caused a few uncomfortable discussions, and this fresh new cardiologist left the area and joined a big-city practice, for he had stumbled into a nice, quiet city that loved its doctors, and did not appreciate having them called out as having missed one diagnosis.

    Why? Well, first, women were once considered 'hysterical' beings, prone to problems that were psychological and not physical. This is hard to overcome, even generations later. And much heart disease is, even today, considered a male problem, as if women all eat well, suffer less stress, and are not physically active.

    How many have died needlessly?

    • by kackle ( 910159 )
      I suffered a lifting injury that supposedly gave me a hiatal hernia (stomach). A hiatal hernia can irritate the vagus nerve, causing it to malfunction. The vagus nerve is responsible for many functions, including keeping the heart rate low/normal. Ever since the injury, I suffer from anxiety attacks and have caused my heart rate to spike just by swallowing something hard (candy), as it seemingly puts further pressure on that nerve as the hard food goes down into the stomach.

      There have been studies sh
  • The study doesn't jump to conclusions

    Well, that's a relief... it is amazing, what insights can be gained from statistics, once you remove the shackles and the blinds imposed by the political correctness.

  • Surely women don't die more. May more often, though :-p

  • That the cases are equivalent. The males may be taking on the more difficult cases. Or they may be given the more difficult cases. Or, they may be called in at the end as a last resort and the death is recorded to them.
  • Since the average age of male physicians and surgeons is 49.1, and the average age of female physicians and surgeons is 42.7 and more recent doctors will be trained better on indentifying female heart attacks - it might be age rather than gender that is giving this result and gender just happens to correlate with age.

  • Somebody with a weak heart is going to be pretty susceptible to things that most people normally brush off. Something that we've recently come to understand is that men make people tense. They don't need to have done anything wrong or have any threatening mannerism; the response is triggered by pheromones and subconscious psychological processes. What would be a barely noticed vague unease for anyone else could be fatal for somebody already teetering on the edge.
  • I'm not sue about the Operating Room thing, but I do more than one person who has had a first heart attack, had the operation and (typically) have stints and arteries replaced. They all are i excellent health today; the oldest had his operation nearly 20 years ago and none have had a post-operative attack. So the ER surgeons are doing something right.

    With women, Estrogen protects them from heart disease until menopause (typically early 40's to mid-50's) but from that point onward heart disease is just as li

  • Maybe male doctors avoid touching female patients, lest they're accused of molesting them.

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