Objective: Since the beginning of the century, the number of cardiac interventions has increased massively and has improved outcomes after cardiac events. The efforts have proven effective with a falling incidence of new cardiovascular diseases. In a small uniform country with a free, fully tax-supported medical system, the previously demonstrated regional differences are not readily explained, and local within-country differences have received little attention. The study aimed to evaluate geographic divergence in referral and invasive treatment of cardiovascular diseases, with a focus on municipality and sex.

Materials and Methods: The mandatory Western Denmark Heart Registry was used to identify all first-entry adult cardiac procedures performed in three western regions from 2014–2020. To compensate for municipality differences in inhabitant composition, only patients aged 40 years or older were included, resulting in a cohort of 110,199 first-entry patients.

Results: Significant differences were found between sexes in referral (females 42.3%) and invasive cardiac treatment (females 19.8% vs. males 38.8%), as well as between municipalities. Females had higher mortality than males after invasive treatments (5-year mortality: females 20.2% vs. males 16.8%), while the opposite result was found after diagnostic evaluation only (5-year mortality: females 7.8% vs. males 11.2%). Marked differences were seen between municipalities without a visible explanatory pattern.

Conclusion: The augmented screening by CTA has likely resulted in improved and faster access to treatment of cardiovascular diseases, but females are still referred less often than males for investigation and higher mortality following invasive treatments remains. Major differences in referral and mortality between regions and municipalities are not readily explained.