title: Are there age and sex differences in the investigation and treatment of heart failure? A population-based study.
abstract: BACKGROUND
  Heart failure is a serious, common, and growing problem. Hospital admissions, which account for the bulk of health service costs associated with heart failure, are becoming more frequent.
  
  
  OBJECTIVE
  To determine whether management of heart failure differs by age and sex.
  
  
  METHODS
  A retrospective case note review of prevalent cases in 16 general practices in West London. Five hundred and eighty-three patients (57% women) with a diagnosis of heart failure were reviewed.
  
  
  RESULTS
  Mean age of patients with heart failure was 78 years (SD = 9.5)--74 years at diagnosis (SD = 10)--and was higher for women than men (76 years versus 71 years, P < 0.001). In 32% of patients there was no record of a chest X-ray, electrocardiogram, or echocardiogram to support diagnosis. Echocardiography, performed in 34% of patients, was less likely in older patients in both sexes (test for trend P = 0.04 in women and 0.02 in men) and, overall, in women (29% compared with 40% of men, P = 0.006). Angiotensin-converting enzyme (ACE) inhibitor treatment, recorded in 54% of patients, decreased with age in both sexes (P < 0.001) and, on unadjusted data, was more likely in men than in women (61% compared with 49%, P = 0.005). On adjustment for age, sex differences in the use of echocardiography and ACE inhibitors were reduced and no longer significant.
  
  
  CONCLUSIONS
  With increasing age, men and women with heart failure were less likely to have undergone echocardiography or to have received an ACE inhibitor. When account was taken of age, there were no statistically significant sex differences in management; however, because of the demographic distribution of heart failure, women are disproportionately affected by age differences in management. Clinical trials, physician practice, and service developments in heart failure have neglected older people. This balance should be redressed.
authors.affiliation: Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
authors.forename: S
authors.initials: S
authors.lastname: Hood
authors.forename: S
authors.initials: S
authors.lastname: Taylor
authors.forename: A
authors.initials: A
authors.lastname: Roeves
authors.forename: A M
authors.initials: AM
authors.lastname: Crook
authors.forename: P
authors.initials: P
authors.lastname: Tlusty
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Kaddoura
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors