C ongestive heart failure (CHF) is the most common cause of hospital admissions in people 65 years of age and older (1). Women represent more than one-half of these CHF hospitalizations (2); thus, it is important to determine whether there are sex-related inequities in the referral and follow-up of CHF patients. A sex-related bias in access to services has been documented in coronary artery disease (3-8) and, to a lesser extent, in CHF (9-12).In the past decade, new developments in treatment have led to improvements in CHF survival, decreased hospital admissions and improved quality of life (13,14). To implement these new treatment regimens, and to account for the growing number of cases and hospitalizations, specialized, multidisciplinary CHF clinics have been established. Benefits of these clinics include reduction in emergency room visits, hospitalization frequency and length of stay, together with reduced cost of care and improvement in quality of life; moreover, there is now some evidence to support their impact on survival (15-20). However, it is unclear whether men and women are equally enrolled in such case management programs, and whether they derive the same benefits. Thus, the purpose of the present study was to evaluate possible sex-related BACKGROUND: Specialized, multidisciplinary clinics improve service provision and reduce morbidity for patients with congestive heart failure (CHF). Although sex-related differences in access to cardiac health services have been reported, it remains unclear whether there are sex-related differences in the use of these specialized services. OBJECTIVES: To evaluate possible sex-related differences in severity at entry into specialized, multidisciplinary clinics, and compare prescription patterns between male and female patients at these clinics. METHODS: Data were obtained from the electronic clinical files of 765 CHF patients newly admitted to any of three main CHF clinics in Montreal, Quebec. Univariate and multivariate models were used to compare differences between sexes. RESULTS: Only 27.1% of patients were female. The mean age (± SD) of the women in the present study was similar to that of the men (64±16 years versus 65±13 years, respectively). Left ventricular ejection fraction at entry for patients with reduced systolic function was comparable between sexes. The New York Heart Association functional class at entry was similar among men and women with systolic dysfunction. However, among patients with preserved systolic function, women were more symptomatic, with a higher functional class at entry (adjusted OR 2.52, 95% CI 1.18 to 5.38). Prescription profiles were similar for men and women. CONCLUSION: Entry into a clinic may be delayed for women with preserved systolic function CHF. However, clinic referral patterns and disease management appeared to be similar among both men and women with systolic dysfunction CHF.
