AMA Study finds a gender gap in use of heart monitors. Why?

Question

U.S. scientists have found women who are offered implantable heart monitors following cardiac arrest are less likely than men to agree to use them. Duke University Medical Center researchers studied the records of more than 236,000 Medicare patients from 1999-2005 and found that when implantable cardioverter-defibrillators, or ICDs, were prescribed, men were two to three times more likely than women to use them.
http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20071004-12210500-bc-us-heartmonitors.xml

Overall, more women than men die of heart disease in the United States each year. Nonetheless, women only receive 33% of angioplasties, stents and bypass surgeries; 36% of open-heart surgeries; and comprise only 25% of participants in heart-related studies, according to the National Coalition for Women with Heart Disease. http://www.womenheart.org/information/women_and_heart_disease_fact

Why the gender gap in use of heart monitors?

Actually, the intial article I saw had a headline implying that women weren't getting the care that men were receiving after a heart attack. I thought there had been quite a bit of education in the medical profession of late about women and heart disease, so I read a couple more articles until I found one about the same study that actually stated the facts: women were being advised correctly, but were choosing not to follow doctor's advice as much as male patients.

It irritated the heck out of me, since the sexist headline got attention, but didn't give us the real facts. There's a huge difference between the correct medical advice being given, and a patient's unwillingness to follow doctors advice. I thought this was important to be aware of since heart disease is a leading cause of death for women as well as men. What needs to be studied is why aren't women willing to use heart monitors?? If it can save your life? I'm in the age group that is at risk--so I'd like to know!

Answer 1

And, women are less likely than are men to be appropriately treated during their first visit to ERs when they present with myocardial infarctions. When I was a Cardiac Intensive Care nurse back in the 1990's, research was barely beginning to address the discrepencies you report here. But, the phenomenon was already recognized. It is interesting for me to see this report after all these years because the phenomenon was troubling to me back then.

Women think psycho-socially about their hearts differently than do men. Their hearts have meaning that is not addressed, for example, in cardiac rehab, which is focused on male cardiac rehab meanings. Cardiac rehab is therefore less effective for women than it is for women. Also, not until this last decade did medical research focus much if at all on significant differences in male and female nutritional requirements. Heart disease can be explored as a function of diet, predisposing genetics, and hypertension.

Among women, diet plays a more significant role in that disease process, and among men hypertension plays a more significant role. Most approaches traditionally focused on preventing and controling heart disease from the perspective of high blood pressure, diuretics, stress reduction, etc. Approaches addressing diet and the psycho-social issues women have with food and food meanings, their unique hormonal and neurochemical responses and interactions with food, have essentially only recently been explored in large studies.

Interventions such as pacemakers and other cardiac hardware are most definitely perceived differently by women than they are by men, related to body and self-image. And, the attitudes of health care professionals toward obesity, women and preconceptions about heart disease being more prominent among men than among women significantly influence treatment and patient education.

Answer 2

Absolute speculation...

There are likely to be a number of reasons.

Several reasons relate to the perception that a woman's risk is lower than a man's. This perception holds in both the public and in the medical profession. Women are likely to be less concerned with the risk, even after having had an event; medical providers too.

Cost may be an issue. Aesthetics may be an issue. I'm probably leaving out some obvious stuff.

I suggest a PubMed search...

Answer 3

The information you offer says that fewer women agree to use them. I think the only way to answer this would be with surveys of patients making such decisions.

My guess - and it is ONLY a guess - is that the fear of having a scar on one's chest may be greater for women for various cultural reasons connected with the perception of women's bodies and sexuality.

EDIT

I didn't see her blame it on man and I can be pretty touchy about such blaming, so I think I would have noticed if she had.

Maybe the phrase "gender gap" threw you, but she didn't say that this was the fault of discrimination or of men. She asked a question.


EDIT

Not every "women's issue" is about blaming men. If my suspicion is right, then the medical profession needs to be more aware of factors influencing women's decisions and to take steps to address them if they believe the best medical option is being rejected.

No blame here. Just medical professionals recognizing the needs of their patients.

And if this is widespread, this would be a good cause for women to speak out about and educate other women about. Acknowledging the difficulties as well as the value of medical procedures women may avoid.

It's much like getting men to have regular prostate exams, despite the cultural reasons for men wishing to avoid them.

It's not about blame. It's about better understanding.

EDIT

I must applaud you for looking further into this issue when faced with initially misleading reports. But then, you've always impressed me as someone who actually investigates questions. One reason I respect you a lot, even when we disagree.

Answer 4

If women who are offered implantable heart monitors following cardiac arrest are less likely than men to agree to use them, I think they should be allowed to have their wish respected. After all if a woman dont want her heart or mind to be monitored, its her right on her body and mind. If there is gender gap in use of heart monitors it is because men are more likely to agree to use them compared to women. If a man wants his heart to be monitored, it is his business and as long as he can afford it, he has every right to get his heart or mind monitored under his wish. I think U.S. scientists have found this very fact to be true that women who are offered implantable heart monitors following cardiac arrest are less likely than men to agree to use them. Hence I think nobody should worry about gender gap in use of heart monitors. But this is only my personal opinion.

The opinions expressed in this answers forum are not to discriminate anybody but to help other people with different sets of opinions and observations to form their own observation. That way everybody can express their opinions as a liberated and free individual.

Thank you

Answer 5

The women CHOSE not to use them?! Only thing I could think of is that they didn't want a defibrillator on their chests. Those things stick out.

Answer 6

It might be that those devices are generally designed for men and don't work as well for women or they might be too large for the average sized woman.

Answer 7

A gender gap in use of heart monitors has the following reason -
1.women are not the primary bread earner in many households hence their lives are valued less hence go in for less regular health checkup

2.the fear of having a scar on one's chest may be greater for women for various cultural reasons connected with the perception of women's bodies and sexuality.

B. statistically speaking "women only receive 33% of angioplasties, stents and bypass surgeries; 36% of open-heart surgeries" is not a meaningful observation since women comprise only 25% of participants in heart-related studies.

what would be of interest is wether sample of women who recieve angioplasties, stents and bypass surgeries of open-heart surgeries from population of participants in heart-related studies is higher.

use chi square test for hypothesis testing

Answer 8

Are there any gender gap issues which affect men adversely?

Answer 9

Coincidence that people love to blow out of proportion. It happens with a lot of stuff.