Differences in managing men and women with heart failure

Lenzen MJ, Rosengren A, Scholte op Reimer W et al, Heart 2007 Jun 17. doi: 10.1136/hrt.2006.099523

This study of discharges and deaths related to heart failure (HF) in 115 hospitals and 24 countries was produced by the Euro Heart Survey on Heart Failure (EHS-HF). In total, 46,788 records were suspected of HF, by analysis of hospital coding and medication charts, although only 10,701 were thought to have suspected or confirmed HF. When this was limited to those with a confirmed diagnosis during index admission or the previous three years, only 8,914 were included. Steps involved in rejecting more than three-quarters of possible records were unclear.

Forty-seven per cent were women, who were significantly older (74.7 versus 68.3 years, p<0.001). Hypertension and diabetes were more common in the women and more men were smokers and heavy alcohol drinkers. Men were more likely to have coronary artery disease (66 per cent versus 56 per cent) and if so, were twice as likely to have had a revascularisation procedure (35 per cent versus 17 per cent).

When women were admitted, they were less likely to go to a specialist cardiology ward or have an echocardiogram (59 per cent versus 74 per cent). This may be related more to age than gender, because younger patients had more admissions to specialist wards and assessment of LV function.

More worryingly, women received less of the evidence-based medication that improves outcome, such as beta-blockers, ACE inhibitors, spironolactone, antithrombotics and more digoxin. Adjusting for age, this remained statistically significant.

This study was performed over 15 months in 2000/1. It demonstrated that men and women were treated differently, even adjusting for age. There were limitations because it was an observational study and there will be some bias because it is assumed that only better hospitals will volunteer to take part. The major factor associated with less satisfactory management for women appeared to be the lower rates of assessment of LV function. This is inevitably associated with less use of the appropriate medication and worse outcome.

The paper confirms that there is absolutely no justification for treating women less intensively and that GPs should all be vigilant in ensuring this does not happen.

- Dr Kathryn Griffith is a GPSI in cardiology, in York

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