TCT.14: Women interventionalists few but procedurally mighty

WASHINGTON, D.C.—Women are a minority in interventional cardiology, but they are taking on more complex procedures in urban settings and experiencing a high level of procedural success. Cindy L. Grines, MD, presented these findings Sept. 14 at the Transcatheter Cardiovascular Therapeutics conference.

Grines, from the Detroit Medical Center Cardiovascular Institute in Detroit, brought this update on the state of women in interventional cardiology to the Featured Clinical Research II panel on behalf of the Women in Innovation (WIN) Study Group.

While 47 percent of medical students were women in 2013, according to Grines, only 10.8 percent of cardiologists were female, with a majority of those being noninvasive, clinical cardiologists.

Grines’ team found that 412 women cardiologists practiced between July 2009 and June 2013. “This represents only 4.5 percent of the nearly 10,000 interventional cardiologists,” Grines stated.

One-third of hospitals employed a female interventionalist, and in many cases she represented the sole female interventionalist on staff (41 percent).  “They were kind of isolated in that regard,” Grines said

Women in interventional cardiology were more likely to be working in an urban (62 percent) or academic (57 percent) setting. Fewer worked in suburban or private practices.

While women make up a small number of interventional cardiologists and performed 2.8 percent of the procedures over the analyzed period, Grines stated, “Despite doing a smaller volume of cases and being somewhat isolated, we’re working on a relatively high-risk population.”

Women treated more patients that presented with cardiogenic shock, STEMI or cardiac arrest in the prior 24 hours, more patients with low income or who were uninsured, and more non-white patients. “Women were more likely to do procedures off hours,” Grines also noted.

Even with the high-risk population, overall mortality was 1.8 percent for patients of women interventionalists. Mortality in patients with acute coronary syndrome was 2.18 percent and for elective PCI 0.46 percent. Little difference was noted between high- and low-volume operators in mortality risk. Grines said, “While we might not be doing as many cases, we’re doing very sick cases and it appears that we’re doing an adequate job with high-risk interventions.”

Grines argued that the high number of high-risk cases was not an intention to be aggressive when treating patients. Rather, that female interventionalists appear to attract fewer private practice patients, which is likely a factor of the urban and academic environments they work in. This leads female interventionalists to take cases as they come.

“There are more women interventionalists overseas,” Grines said. “They all seem to be employed by the hospital and there doesn’t seem to be competition for cases.” Grines noted that the fee-for-service model used in the U.S. means all interventionalists must vie for cases, rather than an equal distribution of work across hospital interventionalists.

Grines said the WIN group is trying to close the gender gap by encouraging and supporting women interested in interventional cardiology.