Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Abstract

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.

Consultation with cardiologists for persons with new-onset chronic heart failure: A population-based study

“…This observation is supported by the findings that there are more men than women admitted to specialized CHF disease management programs (31,32) and that women tend to be followed more by general practitioners than by specialists (33,34).…”

Gender and Other Disparities in Referral to Specialized Heart Failure Clinics Following Emergency Department Visits

“…The average age of our sample was considerably higher than what has been reported in other heart failure clinics. 3,15,16 Even so, the patients in our study lived in the community and not in long-term care facilities, making it possible for them to attend the clinic if referred there.…”

“…14 However, women make up between 26% and 37% of all patients in these specialized multidisciplinary clinics. 3,15,16 Previous studies suggested that women with preserved systolic function HF consulted specialized HF clinics at a more severe point in time in their disease than their male counterparts 15 and that woman had lower health related quality of life (HRQOL) at admission to the clinic compared to men. 17 Although these results may imply the presence of gender disparity in referral since women had a higher severity of disease at entry to the clinic compared to men, there may be other factors that can account for the gender disparity of referral to HF clinics.…”

“…These factors (which also may influence access to HF care) include age, comorbidities, severity of HF, social support, patient preferences, and having regular follow-ups with a primary care physician. 15,16,[18][19][20][21] The main goal of our prospective cohort study was to determine whether there was gender disparity in the referral of patients to specialized HF clinics, in a context in which all residents are publicly insured (and ability to pay or having private health insurance is not an issue). We also sought to identify other factors associated with referral to these clinics.…”

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…Another important area that has not been well explored is whether men and women are equally enrolled in DMPs and whether they derive the same benefits. A recent study has addressed this question and examined the records of 765 patients referred to one of three DMPs in Montreal, Quebec (137). The LVEF and NYHA functional class at entry were similar among men and women with a reduced LVEF.…”