Abstract P187: Assessing Gender Bias in the Treatment of Cardiovascular Disease in Canada

The objective of this study was to determine the presence of gender bias in the treatment of CVD in Canada. Gender bias has been explored extensively in the treatment of CVD, particularly AMI. Previous research is inconsistent in suggesting that women who suffer an AMI are treated less optimally than men. To date, gender bias has not been well addressed in other CVD9s, specifically CVA, CABG, or RRT. In an attempt to get a clearer grasp of the problem, CAP was also studied and served as a control. Retrospective chart reviews for all AMI9s, CVA9s, CABG9s, and CAP9s in 1995/6, 1998/9, and 2000/1 in two locations of Newfoundland (St. John9s and central) were reviewed. Outcomes were analyzed for differences between men and women. Adjusting for baseline differences, regression models were used to assess the following: AMI - time to thrombolytics, admission to CCU, death, discharge beta blockers, ACE/ARB, anti-lipids, ASA; CVA - LOS, transfer to and time to rehabilitation center, death; CABG - time to CABG; CAP - appropriateness of antibiotics (AB), death. RRT was analyzed from the results of the STARRT (Study To Assess Renal Replacement Therapy) study, a Canadian multicentre retrospective chart review of incident dialysis patients followed for six months. Outcomes were explored for differences in care between men and women. Optimal care was based on 1) length of pre-dialysis care; 2) modality choice; 3) access; 4) laboratory parameters at dialysis start; 5) clinical outcomes. Women who had suffered an AMI had a significantly longer time to thrombolytics and were less likely to be admitted to the CCU but did not differ significantly from men in other modes of treatment. Women who were RRT patients began dialysis at a lower eGFR level after receiving less pre-dialysis care than men. Women who received treatment for CAP were less likely than men to receive the appropriate AB9s according to the 1993 guidelines for AB treatment of CAP. There were no significant treatment differences between men and women who had suffered a CVA or who had had a CABG. There were no gender differences in death for any of the diseases. There is little evidence of a significant gender bias in cardiovascular disease in Canada. A potential gender bias in the treatment of CVD patients needs to be explored further.