Patient–Physician Sex Concordance and Outcomes in CVD

Harik L, Yamamoto K, Kimura T, et al.
Patient–Physician Sex Concordance and Outcomes in Cardiovascular Disease: A Systematic Review. Eur Heart J 2024;45:1505-1511.

The following are key points to remember from a systematic review on patient–physician sex concordance and outcomes in cardiovascular disease (CVD):

  1. The sex disparity in outcomes of patients with CVD is well-described and has persisted across recent decades.
  2. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient–physician sex concordance and its association with outcomes.
  3. There is emerging evidence of a positive relationship between patient–physician sex concordance and clinical outcomes, particularly among female patients.
  4. Equally important is the finding that patient–physician sex discordance is most detrimental to clinical outcome in female patients.
  5. The authors review the existing literature on the relationship between patient–physician sex concordance and clinical outcomes in patients with CVD, the evidence of a benefit in clinical outcomes with female patient–physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
  6. Drivers of a benefit of patient–physician sex concordance in female patients are unclear but may include a greater emphasis on preventive care among female physicians, better and more supportive communication from female physicians possibly leading to improved patient adherence, superior clinical outcomes among female physicians, or the absence of implicit physician bias in sex-concordant patient–physician pairs.
  7. The initial data are promising, but they are limited by their retrospective design, by the small number of studies on the topic, by the dearth of female practitioners, and by the low enrollment of female patients in CV studies.
  8. Prospective, randomized clinical trials dedicated only to female patients/participants would provide more definitive answers regarding the benefit of sex concordance.
  9. While randomized trials on patient–physician sex concordance may be difficult to implement, investigating clinical outcomes with patient–physician sex concordance or whether female leadership increases female patient enrollment, increases female entry into CV subspecialties, or mitigates implicit biases may help optimize clinical outcomes in CVD and improve patient-centered care.
  10. Of note, sex is just one factor for which patient–physician concordance may impact clinical outcomes. Early data on patient–physician race concordance in general adult internal medicine have suggested higher patient satisfaction with a race-concordant physician.

Clinical Topics: Prevention

Keywords: Cardiovascular Diseases, Outcome Assessment, Health Care, Sex Differentiation

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