Coronary heart disease: sexual bias in referral for coronary angiogram. How does it work in a state-run health system?

This study examined the effects of a state-run health system on the gender-specific differences in cardiology worldwide, taking coronary angiography as an example. In a prospective study, 476 angiographed patients (155 female, 321 male) were enrolled in consecutive order over a study period of 9 months and asked to answer a standardized questionnaire. The responses showed a discrepancy in the heart death statistics (52.7% female, 47.3% male) and the demographic statistics (51.8% female, 48.2% male). This was true for all age groups. The duration of complaints before undergoing a coronary angiogram was reported to be acute for 4.5% of the women and 13.7% of the men, <1 year for 27.1% of the women and 34% of the men, and >1 year for 68.4% of the women and 52.3% of the men. Women take longer to access coronary angiogram. This is confirmed by New York Heart Association (NYHA) classes I (1.9% female, 7.8% male), II (46.5% female, 65.4% male), III (41.9% female, 21.8% male), and IV (9.7% female, 5.0% male). Prior to angiogram, all of the women and most of the men (98.4%) were under treatment for heart complaints, more women (87.1%) than men (78.8%) took heart medication, but fewer women (29.7%) than men (37.1%) had been referred to a cardiologist. Major differences were seen in the social situation; that is, 68.4% of the women but 93.5% of the men lived with their family, 30.3% of the women but only 5% of the men lived alone, and 1.3% of the women together with 1.6% of the men lived in a care-giving facility. The results of our study show that even in a state-run health system with free access to high-tech medicine at no charge and no age limits, there is a marked gender bias in access to high-tech medicine.