Abstract
Objectives
To assess differences in clinical characteristics, treatment and outcome between men and women with heart failure (HF) treated at a multidisciplinary HF unit. All patients had their first unit visit between August 2001 and April 2004.
Patients
We studied 350 patients, 256 men, with a mean age of 65 ± 10.6 years. In order to assess the pharmacological intervention more homogeneously, the analysis was made at one year of follow‐up.
Results
Women were significantly older than men (69 ± 8.8 years vs. 63.6 ± 10.9 years, p < 0.001). Significant differences were found in the HF etiology and in co‐morbidities. A higher proportion of men were treated with ACEI (83% vs. 68%, p < 0.001) while more women received ARB (18% vs. 8%, p = 0.006), resulting in a similar percentage of patients receiving either of these two drugs (men 91% vs. women 87%). No significant differences were observed in the percentage of patients receiving beta‐blockers, loop diuretics, spironolactone, anticoagulants, amiodarone, nitrates or statins. More women received digoxin (39% vs. 22%, p = 0.001) and more men aspirin (41% vs. 31%, p = 0.004). Carvedilol doses were higher in men (29.4 ± 18.6 vs. 23.8 ± 16.4, p = 0.03), ACEI doses were similar between sexes, and furosemide doses were higher in women (66 mg ± 26.2 vs. 56 mg ± 26.2, p < 0.05). Mortality at 1 year after treatment analysis was similar between sexes (10.4% men vs. 10.5% women).
Conclusions
Despite significant differences in age, etiology and co‐morbidities, differences in treatment between men and women treated at a multidisciplinary HF unit were small. Mortality at 1 year after treatment analysis was similar for both sexes. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: heart failure, treatment, sex
Full Text
The Full Text of this article is available as a PDF (244.5 KB).
References
- 1. Rathore SS, Foody JM, Wang Y, Herrin J, Masoudi FA, et al.: Sex, quality of care, and outcomes of elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project. Am Heart J 2005; 149: 121–128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Simpson CR, Hannaford PC, Williams D: Evidence for inequalities in the management of coronary heart disease in Scotland. Heart 2005; 91: 630–634. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Clinical Quality Improvement Network Investigators. Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure: the relative importance of age, sex, and medical therapy. Arch Intern Med 1996; 156: 1669–1673. [PubMed] [Google Scholar]
- 4. Mejhert M, Holmgren J, Wandell P, Persson H, Edner M: Diagnostic tests, treatment, and follow‐up in heart failure patients‐is there a gender bias in the coherence to guidelines? Eur J Heart Fail 1999; 1: 407–410. [DOI] [PubMed] [Google Scholar]
- 5. Haldeman GA, Croft JB, Giles WH, Rashidee A: Hospitalisation of patients with heart failure: national hospital discharge survey, 1985 to 1996. Am Heart J 1999; 137: 352–360. [DOI] [PubMed] [Google Scholar]
- 6. Philbin EF, DiSalvo TG: Influence of race and gender on care process, resource use, and hospital‐based outcomes in congestive heart failure. Am J Cardiol 1998; 82: 76–81. [DOI] [PubMed] [Google Scholar]
- 7. Harjai KJ, Nunez EJ, Humphrey S, Turgut T, Shah M, et al.: Does gender bias exist in the medical management of heart failure? Int J Cardiol 2000; 75: 65–69. [DOI] [PubMed] [Google Scholar]
- 8. Stromberg A, Martensson J: Gender differences in patients with heart failure. Eur J Cardiovasc Nurs 2003; 2: 7–18. [DOI] [PubMed] [Google Scholar]
- 9. Vaccarino V, Chen YT, Wang Y, Radford MJ, Krumholz HM: Sex differences in the clinical care and outcomes of congestive heart failure in the elderly. Am Heart J 1999; 138: 835–842. [DOI] [PubMed] [Google Scholar]
- 10. Pearson ML, Kahn KL, Harrison ER, Rubenstein LV, Rogers WH, et al.: Differences in quality of care for hospitalized elderly men and women. JAMA 1992; 268: 1883–1889. [PubMed] [Google Scholar]
- 11. Altimir S, Lupón J, González B, Prats M, Parajón T, et al.: Sex and age differences in fragility in a heart failure population. Eur J Heart Fail 2005; 7: 798–802. [DOI] [PubMed] [Google Scholar]
- 12. Shaw LJ, Miller DD, Romeis JC, Kargl D, Younis LT, et al.: Gender differences in the non‐invasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med 1994; 120: 559–566. [DOI] [PubMed] [Google Scholar]
- 13. Gregor RD, Bata IR, Eastwood BJ, Garner JB, Guernsey JR, et al.: Gender differences in the presentation, treatment, and short term mortality of acute chest pain. Clin Invest Med 1994; 17: 551–562. [PubMed] [Google Scholar]
- 14. Schwartz LM, Fisher ES, Tosteson ANA, Woloshin S, Chang C, et al.: Treatment and health outcomes of women and men in a cohort with coronary artery disease. Arch Intern Med 1997; 157: 1545–1551. [PubMed] [Google Scholar]
- 15. Vaccarino V, Rathore SS, Wenger NK, Frederick PD, Abramson JL et al., National Registry of Myocardial Infarction Investigators: Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 2005; 353: 671–682. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Opasich C, De Feo S, Ambrosio GA, Bellis P, Di Lenarda A et al., TEMISTOCLE Investigators: The “real woman” with heart failure. Impact of sex on current in‐hospital management of heart failure by cardiologists and internists. Eur J Heart Fail 2004; 6: 769–779. [DOI] [PubMed] [Google Scholar]
- 17. Burstein JM, Yan R, Weller I, Abramson BL: Management of congestive heart failure: a gender gap may still exist. Observations from a contemporary cohort. BMC Cardiovasc Disord 2003; 3: 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Lund LH, Mancini D: Heart failure in women. Med Clin North Am 2004; 88: 1321–1345. [DOI] [PubMed] [Google Scholar]
- 19. Fernandez‐Sola J, Estruch R, Nicolas JM, Pare JC, Sacanella E, et al.: Comparison of alcoholic cardiomyopathy in women versus men. Am J Cardiol 1997; 80: 481–485. [DOI] [PubMed] [Google Scholar]
- 20. Ofili EO, Mayberry R, Alema‐Mensah E, Saleem S, Hamirani K, et al.: Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African‐American patients. Am J Cardiol 1999; 83: 1350–1355. [DOI] [PubMed] [Google Scholar]
- 21. Piano MR: Alcoholic cardiomyopathy. Incidence, clinical characteristics, and pathophysiology. Chest 2002; 121: 1638–1650. [DOI] [PubMed] [Google Scholar]
- 22.The SOLVD Investigators. Adverse effects of enalapril in the studies of left ventricular dysfunction. Am Heart J 1996; 131: 350–353. [DOI] [PubMed] [Google Scholar]
- 23. Meune C, Mahe I, Mourad JJ, Simoneau G, Knellwolf AL, et al.: Interaction between angiotensin‐converting enzyme inhibitors and aspirin: a review. Eur J Clin Pharmacol 2000; 56: 609–620. [DOI] [PubMed] [Google Scholar]
- 24. Pearson ML, Kahn KL, Harrison ER, Rubenstein LV, Rogers WH, et al.: Differences in quality of care for hospitalised elderly men and women. JAMA 1992; 268: 1883–1889. [PubMed] [Google Scholar]
- 25. Ho KKL, Anderson KM, Kannel WB, Grosssman W, Levy D: Survival after the outset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993; 88: 107–115. [DOI] [PubMed] [Google Scholar]