The following is a summary of “Influence of Patient and Clinician Gender on Emergency Department HEART Scores: A Secondary Analysis of a Prospective Observational Trial,” published in the February 2024 issue of Emergency Medicine by Barron, et al.

Healthcare gaps can be reduced with the help of clinical decision tools. However, many clinical decision tools have subjective factors that could bring bias from the doctor. The HEART score is a clinical decision that helps doctors tell how likely a patient in the emergency department (ED) will have a heart attack. 

For a study, researchers sought to find out how gender affects HEART scores for both patients and clinicians. 

They looked at a random group of adult ED patients at one hospital who came in with signs of acute cardiac syndrome in this secondary analysis of a prospective observational study. They looked at HEART scores made by ED clinicians and scores made by researchers who didn’t know what gender the patient was. The main result was whether the HEART numbers given by the physician and researcher were the same for each patient’s gender and each therapist’s gender. They used difference-in-difference (DiD) to compare continuous scores and prevalence-adjusted, bias-adjusted Kappa (PABAK) to compare binary scores (low risk vs. moderate/high risk). All 336 pairs of clinicians and patients from the original study were considered. 47% of the patients were women (158/336), and 52% were handled by women clinicians (174/336). 

The difference between the doctor’s and researcher’s HEART scores for male and female patients was 0.24 (95% CI −0.01 to 0.48). They found that male clinicians gave male patients a higher score than female patients (DiD 0.51 [95% CI 0.16 to 0.87]), but female clinicians did not (DiD 0.00 [95% CI −0.33 to 0.33]). It was most agreed upon between female clinicians (PABAK 0.72; 95% CI 0.61 to 0.81) and least agreed upon between male clinicians evaluating male patients (PABAK 0.47; 95% CI 0.29 to 0.66). The gender of the patient and the doctor may affect the HEART score. When this and other professional decision aids are being made and used, researchers should try to understand these factors.

Source: sciencedirect.com/science/article/abs/pii/S0196064423001993