Crilly Michael A, Bundred Peter E, Leckey Lisa C, Johnstone Fiona C
Department of Public Health, University of Aberdeen Medical School, Aberdeen, AB25 2ZD, U.K.
J Womens Health (Larchmt). 2008 Apr;17(3):331-42. doi: 10.1089/jwh.2007.0383.
Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in primary care.
The study design is a cross-sectional survey of 1162 angina patients (552 women) managed in eight sentinel centers serving 15% of the population of Liverpool. Data were extracted by specially trained data managers. Analysis included directly age-standardized proportions and male/female adjusted odds ratios (AOR), adjusted for age, disease duration, physician consultation rate, and age at diagnosis.
All aspects of care were higher for men with angina-previous myocardial infarction (MI) than for women with angina-previous MI. Risk factor recording was an absolute 8% higher (95% CI 1%-17%), secondary prevention 9% higher (95% CI 1%-17%), cardiac investigation 10% higher (95% CI 1%-20%), and revascularization 13% higher (95% CI 4%-22%). Men with angina-previous MI consistently received the highest level and women with angina the lowest level of risk factor recording (AOR 1.79, 95% CI 1.21-2.66), secondary prevention (AOR 2.24, 95% CI 1.47-3.40), cardiac investigation (AOR 2.21, 95% CI 1.56-3.13), and revascularization (AOR 4.67, 95% CI 3.03-7.18). The provision of care to men with angina alone and women with angina-previous MI fell between these two extremes.
A gender-based clinical hierarchy operates in the clinical management of angina pectoris in primary care. The Yentl syndrome did not apply, however, as women with angina received less intensive clinical care than similar men irrespective of prior MI.
患有心脏病的女性可能比男性接受的临床护理水平更低。我们评估了“延特综合征”（即女性只有在像男性一样发作心脏病时才会得到与男性同等的护理）是否在初级保健中心绞痛的管理中存在。
本研究设计为一项横断面调查，对在利物浦15%人口的八个哨点中心管理的1162名心绞痛患者（552名女性）进行调查。数据由经过专门培训的数据管理人员提取。分析包括直接年龄标准化比例和男性/女性调整优势比（AOR），并对年龄、疾病持续时间、医生会诊率和诊断年龄进行了调整。
患有心绞痛-既往心肌梗死（MI）的男性在护理的各个方面都高于患有心绞痛-既往MI的女性。危险因素记录绝对高出8%（95%CI 1%-17%），二级预防高出9%（95%CI 1%-17%），心脏检查高出10%（95%CI 1%-20%），血运重建高出13%（95%CI 4%-22%）。患有心绞痛-既往MI的男性始终接受最高水平的护理，而患有心绞痛的女性接受危险因素记录（AOR 1.79，95%CI 1.21-2.66）、二级预防（AOR 2.24，95%CI 1.47-3.40）、心脏检查（AOR 2.21，95%CI 1.56-3.13）和血运重建（AOR 4.67，95%CI 3.03-7.18）的水平最低。仅患有心绞痛的男性和患有心绞痛-既往MI的女性的护理水平介于这两个极端之间。
在初级保健中心绞痛的临床管理中存在基于性别的临床等级制度。然而，“延特综合征”并不适用，因为患有心绞痛的女性无论既往是否有心肌梗死，接受的强化临床护理都比类似男性少。
