ACC Study Finds Female Heart Disease Patients Fare Better When Treated by Female Physicians

February 22, 2021—The American College of Cardiology (ACC) announced the publication of findings from a systematic review from the ACC’s Cardiovascular Disease in Women section that showed that female physicians have better patient outcomes compared with their male peers, while female patients are less likely to receive guideline-recommended care when treated by a male physician.

The study was published by Emily S. Lau, MD, et al in the Journal of the American College of Cardiology (2021;77:1135-1138).

As noted in the ACC press release, more than 50% of internal medicine residents are female, but only 12.6% of cardiologists are female. A dedicated effort to increase diversity in the cardiovascular field could help lower implicit bias, which is often considered an important factor in health care disparities.

According to ACC, the investigators who conducted this detailed systematic review included 13 studies examining the patient-physician gender relationship across multiple specialties and its role in the care patients receive. Eight of these studies examined patient outcomes based on physician gender. The investigators found data supporting the suggestion that a patient’s outcomes may be positively influenced if he or she is treated by a physician of the same gender.

ACC noted that in one study, the investigators found that female patients with diabetes were less likely to receive intense treatment than male patients, particularly when treated by a male primary care provider. In another study, mortality rates for heart attack patients were highest among female patients treated by male physicians. If the treating physician was female, mortality rates remained the same between male and female patients. The study concluded that male physicians who had more exposure to female patients and physicians had more success in treating female patients.

Although care disparities can be attributed to multiple factors, the study investigators found they may relate, in part, to the differences in how heart disease presents in women versus men, the underrepresentation of female patients in clinical trials, and the lack of women’s health training in United States medical education.

The ACC press release outlines the investigators’ three proposed major recommendations to address these findings:

1. Increase Gender Diversity in the Physician Workforce

• Create interventions designed to address existing implicit and explicit biases, which have limited opportunities for women in cardiovascular medicine
• Change the culture of cardiology to be more female- and family-friendly
• Increase representation of women in leadership positions in cardiovascular medicine

2. Improve Gender- and Sex-Specific Medical Training

• Focus curricula on the presentation, diagnosis, and treatment of women and men and highlight specific differences
• Include comprehensive behavioral health curriculum to address stress, depression, and anxiety faced by women, as well as men, with heart disease
• Teach patient-centered communication styles
• Introduce implicit bias training

3. Increase Research on the Role of Gender in Patient-Physician Relationships

• Focus on nonrandomized experimental designs that incorporate economic approaches with medical research

The senior investigator of the study is Malissa J. Wood, MD, who is Codirector of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital in Boston, Massachusetts, as well as Incoming Chair-Elect of the ACC Board of Governors.

In the ACC announcement, Dr. Wood commented, “We must continue encouraging young physicians from diverse backgrounds to enter the field of cardiology in order for our physician workforce to more accurately reflect the gender composition of our overall patient population. It is imperative that we ensure that all physicians provide the same level of high-quality care for all patients, regardless of gender. We need to incorporate comprehensive patient-centered communication and care into medical education.”

Dr. Wood continued, “A better understanding of the mechanisms driving gender differences in patient outcomes, including whether patient-physician gender concordance truly impacts patient outcomes, can help guide targets for interventions. More research is needed to understand the physician behaviors associated with improved patient outcomes, specifically in driving differential outcomes in gender patient-physician pairings, including drivers of implicit and explicit bias.”

The ACC’s CardioSmart Women and Heart Disease Hub provides information on women and heart disease, including a new “Women and Heart Disease” infographic, noted the society’s press release.