Gender inequalities in the management of angina pectoris: cross sectional survey in primary care

Background and Aims: To determine the extent of gender differences in the routine clinical care of patients with angina pectoris in primary care. Methods: A cross-sectional survey of general practitioner (GP) medical records undertaken by trained data managers in 6 GP practices. 925 adults (489 men) with a clinical diagnosis of angina (prevalence = 2.4%, 95%CI 2.3-2.6). Data extracted included: level of care; risk factor recording; prescribed medication; exercise ECG and coronary revascularisation. Adjusted male-to-female odds ratios (AOR) adjusted for age, angina duration, and previous myocardial infarction, (MI). Results: Women with angina were older than men (71 v 65 years) with a lower prevalence of MI (30 v 45%), but a longer duration of angina (5 v 4years). Men were more likely to receive once daily aspirin (AOR= 2.07, 95%CI 1.56-2.74) and be prescribed triple anti-anginal therapy (1.58, 95%CI 1.03-2.42). Men were also significantly more likely to undergo exercise ECG (1-56, 95%CI 1.14-2.15) and surgical revascularisation (1,71, 95%CI 1.03-2.85). Women tended to receive GP care alone (AOR=0.64, 95%CI 0.46-0.89), whilst men received specialist cardiac care (1.47, 95%CI 1.09-2.00). Beta-blocker usefollowing MI was similar (0.99, 95%CI 0.59-1.69). Conclusion: Differences in the management of men and women are unaccounted for by differences in age, previous MI or duration of angina. Gender differences in management of CHD reported from secondary care may also exist in primary care.