Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care

Background: Previous research suggests that women admitted to hospital with acute myocardial infarction (MI) are managed less intensively than men. Chronic stable angina is the commonest clinical manifestation of coronary heart disease in the community, but little information is available concerning its contemporary clinical management. The aim of this study is to assess the extent of gender differences in the clinical management of angina pectoris in primary care.

Methods: A cross-sectional survey undertaken in 8 sentinel centres serving 63,724 individuals in the city of Liverpool ( 15% of the city population). Aspects of clinical care assessed included: risk factor recording (smoking, cholesterol, blood pressure, body mass index); secondary prevention (aspirin, beta-blocker, statin); cardiac investigation (exercise ECG, perfusion scanning, angiography); and revascularisation (percutaneous coronary intervention, coronary artery bypass grafting). Male-to-female adjusted odds ratios (AOR) were calculated ( adjusted for age, angina duration, age at diagnosis and previous MI) using logistic regression.

Results: 1,162 patients ( 610 men; 552 women) with angina were identified. Women were older than men ( 71 vs 67 years), with a shorter duration of angina ( 6 vs 7 years), and a lower prevalence of previous MI (25% vs 43%). Men were significantly more likely than women to undergo detailed risk factor assessment ( AOR = 1.35, 95% CI 1.06 to 1.73); receive 'triple' secondary prevention with aspirin, beta-blockers and statins ( AOR = 1.47, 95% CI 1.07 to 2.02); access exercise ECG testing ( AOR = 1.31, 95% CI 1.02 to 1.68); angiography ( AOR = 1.61, 95% CI 1.23 to 2.12); and undergo coronary revascularisation (AOR = 1.93, 95% CI 1.39 to 2.68).

Conclusion: Systematic gender differences exist in the comprehensive clinical management of patients with angina in primary care.