Practice Patterns of Female Interventionalists Show High Volume of Complex Cases

While the number of women working as interventional cardiologists remains low — with operators often isolated professionally from female colleagues — there are positive signs of change. In particular, according to registry findings presented at TCT 2014, female interventionalists are more likely to tackle high-risk cases, such as STEMI, cardiac arrest and cardiogenic shock.

To learn more about practice patterns of female interventional cardiologists, Cindy L. Grines, MD, of Detroit Medical Center in Detroit, Mich., and current chair of the SCAI-Women in Innovations (WIN) initiative, and colleagues analyzed data from the NCDR CathPCI Registry on 2,465,685 PCI procedures performed at 1,431 U.S. hospitals between July 1, 2009, and June 30, 2013.

Women accounted for only 4.5% of all interventionalists. In addition, 41% of female interventionalists operated at a hospital with no other women in the same profession, and female operators performed a mere 2.8% of all PCI procedures.

Patterns of practice 

The researchers observed that female interventionalists tended to practice in academic (57%) and urban (62%) hospitals. Compared with male operators, female operators were slightly less likely to treat white patients and more likely to treat uninsured patients. Male and female interventionalists were equally likely to treat female patients.

In addition, female operators were found to be as or more likely to take on high-risk cases as their male counterparts (see Figure).

“From the analysis, it appears that women were more likely to perform procedures off-hours and performed procedures on a higher percentage of STEMI and non-STEMI patients,” Grines said, highlighting that approximately 42.2% of cases done by women were in patients with acute MI. “This is significant,” she stressed, “because despite handling a smaller volume of cases, and being somewhat isolated, female interventionalists are working with a relatively high-risk population.”

Women performing well irrespective of volume 

Female operators reported conducting a median of 48 procedures per year. Because women in the field were found to often be low-volume operators, Grines and colleagues decided to specifically examine differences based on volume. After adjustment for variables in the CathPCI mortality risk model, there was no disparity between high- and low-volume female operators in post-PCI mortality risk (OR 1.03; 95% CI 0.84-1.27).

“Even though females are not doing as many cases as males, females are handling a higher proportion of very sick cases, and it appears that women are doing a very adequate job with high-risk interventions,” said Grines, noting that the study was not able to ascertain other operator characteristics, such as years in practice, or measure longitudinal outcomes after PCI.

“The good news,” she added, “is that we are gradually increasing the number of procedures performed by females. [However], this analysis also illustrates that there is a significant gap, and Women in Innovations is trying to address this and encourage/support more women who may want to go into interventional cardiology.”

Disclosures: 

• Grines reports serving as a consultant to or on the advisory board of multiple pharmaceutical and device companies and as editor-in-chief of the Journal of Interventional Cardiology.