Does gender bias exist in the medical management of heart failure?

Gender Differences in Adherence to the Sodium-Restricted Diet in Patients With Heart Failure

“…Several investigators have reported that women differ from men in many HF outcomes, 14,[39][40][41] but little is known regarding whether these gender differences are due to adherence rates. Only two groups of investigators have compared gender differences in adherence to medication among patients with HF 8,42 but neither examined gender differences in adherence to a SRD.…”

Demographics, Treatment Regimens and the Use of Angiotensin-Receptor Blockers in Heart Failure: Findings from the Valsartan Heart Failure Trial

“…15,16 Some data also indicate that treatment guidelines are followed less strictly for women, 17 and that a gender bias exists in treatment selection. 18 The aetiology of HF differs between the sexes, and women with HF appear to have normal systolic function more frequently than men. 19 …”

Sex, quality of care, and outcomes of elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project

“…Women with heart failure treated in the ambulatory setting are less frequently treated with angiotensin-converting enzyme (ACE) inhibitors, [4][5][6] digoxin, 5 and antiplatelet agents 6,7 than men. Sex differences in heart failure treatment have also been reported during hospitalization, including lower rates of ACE inhibitor use, 8,9 combination medical therapy, 10 use of cardiac procedures, 1,9,11 and poorer performance on other explicit and implicit process-of-care measures, 12,13 leading to suggestions of gender bias. 10 However, the evidence is not consistent, as other studies of heart failure have reported that women have similar or higher rates of ACE inhibitor prescription, [14][15][16] diuretic use, 5,6,15,16 procedure use, 9,15 and overall process quality of care as men.…”

“…Sex differences in heart failure treatment have also been reported during hospitalization, including lower rates of ACE inhibitor use, 8,9 combination medical therapy, 10 use of cardiac procedures, 1,9,11 and poorer performance on other explicit and implicit process-of-care measures, 12,13 leading to suggestions of gender bias. 10 However, the evidence is not consistent, as other studies of heart failure have reported that women have similar or higher rates of ACE inhibitor prescription, [14][15][16] diuretic use, 5,6,15,16 procedure use, 9,15 and overall process quality of care as men. 17 Women have also been reported, by some studies, to have better outcomes than men, both after initial diagnosis of heart failure, 3,18 during hospitalization, 11 and after discharge.…”

“…27 Discrepant findings concerning the association of patient sex, quality of care, and mortality may reflect the limitations of previous studies. The association of patient sex, quality of care, and mortality has been primarily assessed using data from single centers, specific geographic regions, or selected patient populations 5,[8][9][10][11][12][13][14][15][16][17][18]20,21,[25][26][27][28][29] and, thus, may not reflect national patterns of care or outcomes. Prior studies have also commonly utilized administrative data and, thus, been unable to account adequately for clinical characteristics that may confound the association of patient sex, treatment, and outcomes.…”