Women with atherosclerotic cardiovascular disease (ASCVD) were more likely to report worse experiences with the healthcare system and a lower health-related quality of life in a nationally representative study—highlighting another area where cardiovascular care potentially lags behind for women.
The retrospective study from senior author Erin D. Michos, MD, MHS, with Johns Hopkins School of Medicine, and colleagues included 21,353 individuals with ASCVD, 47 percent of whom were women. It used Medical Expenditure Panel Survey data to provide insight into patients’ perceptions of health status and satisfaction with the healthcare system, including provider communication.
Participants answered questions about whether healthcare providers listened carefully to them, spent enough time with them, respected what they had to say and explained things in a way that was easy to understand. Each of those four categories was rated from 1 to 3—never/sometimes, usually and always—and those scores were weighted to determine whether the patient-provider communication was “poor,” “average” or “optimal.” Patient satisfaction was also rated on a scale from 0 to 10, with scores of 3 and below representing poor patient satisfaction and scores of 4 and higher representing excellent/good patient satisfaction.
Compared to men with ASCVD, women with the same condition were 12 percent more likely to report poor healthcare satisfaction and 25 percent more likely to report poor patient-provider communication. They were also 15 percent more likely to perceive their health status as poor, less likely to use preventive aspirin and statins and 28 percent more likely to visit the emergency department at least twice a year.
“Negative patient experience may be a contributing factor to some of the worse outcomes demonstrated among women with ASCVD,” Michos et al. wrote in the Journal of the American Heart Association. “It is therefore important to explore the likely mechanisms responsible for the poor patient experience among women with ASCVD and possible solutions to address these disparities, which may provide better chances for improved and equitable healthcare delivery.”
The authors said women might have higher expectations of their healthcare providers and desire more participatory or interactive conversations with them. When clinicians don’t meet those ideals, patient satisfaction may suffer as a result, Michos and colleagues suggested.
Even after adjusting for cardiovascular risk factors, income, race and health insurance, among other factors, women were 45 percent less likely than men to use statins and 35 percent less likely to use aspirin.
Women who visited with a female healthcare provider were 22 percent less likely to perceive their health status as poor and attained higher average scores on the physical component of a health-related quality of life evaluation. Provider gender didn’t appear to influence the patient-reported outcomes of male participants, the researchers found.
“Gender differences in cardiovascular outcomes are beyond the influence of biological and medical factors, as they extend to the psychosocial and patient‐centered determinants of health,” Michos et al. wrote. “Improved recognition and understanding of these gender‐specific differences and challenges among women with ASCVD will be vital to the improvement of women's cardiovascular health.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.