Circ: Both sexes receive similar HF care at Get with the Guidelines hospitals

Despite the fact that recent research has outlined disparities in hospital care, a study published Aug. 23 in Circulation: Heart Failure showed that women received nearly the same quality of care as men who are treated at hospitals that use the American Heart Association’s Get with the Guidelines—Heart Failure program. However, while the quality is there, patients may still not receive recommended treatments.

“Epidemiologic and clinical studies have suggested sex-related differences in the incidence and prognosis of outpatients with HF, as well as in the delivery of guideline-recommended HF treatments,” wrote Liviu Klein, MD, MS, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues. “Yet, their under-representation in clinical HF trials has limited our understanding of potential sex-related differences in the impact of management strategies and outcomes.”

To address these gaps, Klein and colleagues set out to evaluate data on hospitalizations, quality of care and in-hospital mortality to investigate the differences in outcomes between sex for HF patients.

To do so, the authors used the Get with the Guidelines—HF registry and identified 99,841 patients who received care at 247 hospitals. Women accounted for nearly half of the 99,841 total admissions.

The researchers reported that over time, there was a decrease in the percentage of women admitted with HF, 50.5 percent in 2005 to 48.1 percent in 2009. Women in the registry were older, had lower rates of diagnosed coronary artery disease, peripheral vascular disease and renal insufficiency, but had higher rates of hypertension and anemia when compared to men.

These data showed that women were less likely to undergo interventions compared with men, 18 percent versus 25 percent. Additionally, there were a total of 2,914 in-hospital deaths reported during the study; 1,472 of them were women. After the authors adjusted for medical history, systolic blood pressure, heart rate, left ventricular ejection fraction, among others, women had similar in-hospital mortality to men.

The main study findings were as follows:

• Women constitute half of the patients admitted to the hospital with HF. However, women have different comorbidities and clinical profiles from men, but similar presenting symptoms;

• Performance measures for HF quality of care are similar between men and women and there are little gender/race or gender/age interactions;
• Implantable cardioverter defibrillator (ICD) implantations occur in a lower proportion of women compared to men, 32 percent versus 45 percent;
• Anticoagulation for atrial fibrillation is underused and is administered to fewer women than men; and
• Women who are hospitalized for HF have an increased length of stay and are less likely to undergo procedures.

“There’s nothing apparent from our study as to why women were less likely to receive any of these treatments,” Klein said in a statement. “We also aren't sure why women had a 10 percent higher chance of being hospitalized for more than a week. The gender gap for this and other measures will require further study.”

The authors concluded that the study findings outline a bigger issue: Although quality of care measures improved for men and women, even men may not always receive the most optimal therapy. For example, only two-thirds of men received anticoagulants and less than half received ICDs.

“Further research is needed to understand the reasons for these differences at the patient, physician, and hospital levels,” the authors concluded.