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

Feldman, Debbie Ehrmann; Huynh, Thao; Lauriers, Julie Des; Giannetti, Nadia; Frenette, Marc; Grondin, François; Michel, Caroline; Sheppard, Richard; Montigny, Martine; Lepage, Serge; Nguyen, Viviane; Behlouli, Hassan; Pilote, Louise

doi:10.1089/jwh.2012.4107

Cited by 25 publications

(46 citation statements)

References 32 publications

(37 reference statements)

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“…Within the field of cardiovascular medicine, Feldman et al 15 have shown that women with congestive heart failure are less likely to receive specialty heart failure care than do men. In both the inpatient and outpatient settings, women with coronary artery disease receive less aggressive care than do their male counterparts.…”

Section: Discussionmentioning

confidence: 99%

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

et al. 2015

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BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. OBJECTIVE We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. METHODS We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010–2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiolo-gist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. RESULTS Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63–0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63–0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92–0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93–0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93–0.94; P < .001). CONCLUSION Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.

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Section: Discussionmentioning

confidence: 99%

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

et al. 2015

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“…Women with symptoms of coronary heart disease are not treated as aggressively as males (Feldman et al . 2013). Although prevalence of arthritis is greater in women than men, and women are affected with greater severity, women are not offered the same treatment options as men (Godfrey and Nelson 2008).…”

Section: Literature Review: Ageism Sexism Older Women and Physiciansmentioning

confidence: 99%

‘My opinion is that doctors prefer younger people’: older women, physicians and ageism

MacRae

2016

Ageing and Society

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This study examines older women's views about and subjective experience of ageism during interactions with physicians. Views about and experience of sexism are also examined. Data were obtained from in-depth, face-to-face interviews conducted with 36 Canadian women 55 years and older. The findings indicate that older women believe ageism is likely to occur during medical encounters and are concerned about it. Few, however, claim to have personally experienced it. Contradicting the stereotype of the passive older patient, many participants were employing strategies to avoid becoming targets of ageism. Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.

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“… 6 Female congestive heart failure patients are less likely to be treated by a heart failure specialist than men with the same illness. 7 In a recent, large study of Medicare beneficiaries, we found differences in AF treatment according to race and sex, including pharmacologic and nonpharmacologic modalities. 8 To investigate whether similar disparities exist in the use of catheter ablation for symptomatic AF in patients across multiple insurance types, we compared the demographic characteristics of patients of who did or did not undergo catheter ablation after presentation to the hospital with AF.…”

mentioning

confidence: 93%

Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation

Kummer

Bhave

Merkler

et al. 2015

JAHA

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BackgroundCatheter ablation is increasingly used for rhythm control in symptomatic atrial fibrillation (AF), but the demographic characteristics of patients undergoing this procedure are unclear.Methods and ResultsWe used data on all admissions at nonfederal acute care hospitals in California, Florida, and New York to identify patients discharged with a primary diagnosis of AF between 2006 and 2011. Our primary outcome was readmission for catheter ablation of AF, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Cox regression models were used to assess relationships between demographic characteristics and catheter ablation, adjusting for Elixhauser comorbidities. We identified 397 612 eligible patients. Of these, 16 717 (4.20%, 95% CI 0.41 to 0.43) underwent ablation. These patients were significantly younger, more often male, more often white, and more often privately insured, with higher household incomes and lower rates of medical comorbidity. In Cox regression models, the likelihood of ablation was lower in women than men (hazard ratio [HR] 0.83; 95% CI 0.80 to 0.86) despite higher rates of AF-related rehospitalization (HR 1.23; 95% CI 1.21 to 1.24). Compared to whites, the likelihood of ablation was lower in Hispanics (HR 0.60; 95% CI 0.56 to 0.64) and blacks (HR 0.68; 95% CI 0.64 to 0.73), even though blacks had only a slightly lower likelihood of AF-related rehospitalization (HR 0.97; 95% CI 0.94 to 0.99) and a higher likelihood of all-cause hospitalization (HR 1.38; 95% CI 1.37 to 1.39). Essentially the same pattern existed in Hispanics.ConclusionsWe found differences in use of catheter ablation for symptomatic AF according to sex and race despite adjustment for available data on demographic characteristics and medical comorbidities.

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

Abstract: There are disparities in referral with respect to gender, age, and type of HF. These disparities in referral need to be addressed.

Cited by 25 publications

References 32 publications

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation

‘My opinion is that doctors prefer younger people’: older women, physicians and ageism

Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation

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