P&S Journal: Spring 1994, Vol.14, No.2
Centering on Heart Failure
Outcomes Research: Women and Heart Failure
Other research at the center involves the study of access to health care and health outcomes for heart failure patients.
There is conflicting evidence as to whether physicians pursue a less aggressive approach in evaluating and treating coronary artery disease in women. Because women are underrepresented among cardiac transplant recipients (even after accounting for gender differences in the incidence, age of onset, and severity of heart failure), Dr. Keith Aaronson, assistant professor of medicine, in collaboration with Dr. Donna Mancini, medical director of cardiac transplantation and assistant professor of medicine, is investigating what role gender has in heart transplant candidate selection. His analysis of data from a large sample of patients evaluated at the University of Pennsylvania revealed no evidence of gender bias by physicians in the selection of heart transplant candidates. However, when transplantation was offered as the best medical option, women were much more likely than men to refuse transplantation.
Dr. Aaronson is expanding this research at CPMC to determine what factors may influence women and their decisions. "Were these decisions influenced by socioeconomic or educational differences? Does this reflect a lesser willingness by women to accept a greater risk of early mortality in return for the potential of an improved long-term survival and quality of life? Are their subtle differences in the way information about transplants is presented to men and women?" Dr. Aaronson also conducts research aimed at improving criteria used to determine which patients are accepted for cardiac transplantation. While the number of patients placed on transplant waiting lists continues to grow, the number of donor hearts available for transplantation has remained constant. Dr. Aaronson is developing a statistical model that will provide a means to identify heart failure patients at greatest risk of death without a transplant.