Female Interventionalists 'Very Rare,' Work in Isolation

September 16, 2014

WASHINGTON, DC — Just 4.5% of the interventional cardiologists in the United States are women, and 41% of these women operate at institutions where there are no other female interventionalists, according to a new analysis presented this week here at TCT 2014 .

In the United States, just one-third of the 1431 hospitals surveyed had a female interventionalist on staff.

Dr Cindy Grines (Detroit Medical Center, MI), who presented the data on behalf of the Women in Innovations initiative by the Society for Cardiovascular Angiography and Interventions, said that women are low-volume operators, performing 48 PCIs per year.

Despite the low volume, Grines said that women are taking on difficult cases, with women slightly more likely than men to take on STEMI and NSTEMI indications for PCI, perform PCI on patients who went into cardiogenic shock in the preceding 24 hours, and perform PCI outside normal working hours. "This might represent the practice pattern," said Grines. "I don't think we intentionally try to be more aggressive, but we're not as good at getting the private-practice type of patients."

Dr Cindy Grines

For the analysis, the researchers analyzed data from the CathPCI Registry , including 2.5 million PCI procedures performed at hospitals in the US between 2009 and 2013. Of the 9179 interventional cardiologists identified, just 412 were women. The women were more likely to work in urban and academic settings.

As noted, women are also low-volume operators, performing 2.8% of all PCI procedures in the United States. There tended to be a larger number of female invasive coronary interventionalists in Alaska, Hawaii, New England, Ohio, Georgia, and Florida, as well as in the North-Central and Southwestern states. "It's hard to say what makes people move to these areas," said Grines. "It's just what the data show."

The patient mix was fairly similar between men and women, with no major differences in patient comorbidities. In terms of presentation, 15.6% of women did PCIs off hours vs 14.2% of men. Nearly 20% of cases handled by women were for STEMI vs 16.5% by men.

"In addition, it didn't appear that we shied away from other sick patients," said Grines. "Despite doing a smaller volume of cases and being somewhat isolated, we're really doing a high-risk population."

Regarding mortality outcomes, Grines said that in-hospital mortality was 1.8% overall, which might seem high but likely reflects the higher-risk patients. For ACS and elective PCI patients, the in-hospital mortality rate was 2.18% and 0.46%, respectively.

Grines said there is an awareness that women are underrepresented in cardiology. In 2013, 47% of medical students were female, and the Association of American Medical Colleges has reported than 10.8% of active cardiologists are women, but the vast majority are noninvasive.


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