Effect of gender on treatment, resource utilization, and outcomes in congestive heart failure in Quebec, Canada.
This study assessed whether a gender gap exists in therapy, procedure use, and outcomes in patients who have a new diagnosis of congestive heart failure (CHF) at the population level. The Quebec hospital discharge database was linked with the physician and drug claims databases to identify a cohort of patients who had a diagnosis of CHF (code 428 in the International Classification of Diseases, Ninth Revision) between January 1998 and December 2002. There were 16,017 men and 16,622 women. Women who had CHF were older (78 +/- 11 vs 73 +/- 11 years, p <0.001), had more hypertension (41% vs 28%, p <0.001) and hyperlipidemia (18% vs 14%, p <0.001) but less frequent myocardial infarction (19% vs 25%, p <0.001). Women were less likely to see a cardiologist (30% vs 34%, p <0.001) and required a longer hospital stay (12.0 +/- 14.8 vs 10.6 +/- 13.3 days, p <0.001). During the first year after a first CHF hospitalization, women were less like to have an assessment of left ventricular function (61% vs 65%, p <0.001), diagnostic cardiac catheterization (11% vs 15%, p <0.001), and revascularization procedure (4% vs 6%, p <0.001). Women were less likely to be prescribed an angiotensin-converting enzyme inhibitor (60% vs 66%) and more likely to be prescribed a beta blocker (38% vs 34%). Women and men had similar yearly numbers of rehospitalizations for CHF (1.4 +/- 1.0 vs 1.5 +/- 1.0) and emergency room visits (1.7 +/- 1.2 vs 1.8 +/- 1.3). The adjusted risk of death was minimally higher in men than in women (hazard ratio 1.06, 95% confidence interval 1.03 to 1.1, p <0.01). Thus, despite less frequent cardiologist assessment, fewer cardiac-related procedures, and less frequent use of standard medical therapy, clinical outcomes in women and men who had CHF were similar.
Sheppard
Richard
R
Sir Mortimer B. Davis/Jewish General Hospital, Montreal, Quebec, Canada.
Behlouli
Hassan
H
Richard
Hugues
H
Pilote
Louise
L
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D002309:Cardiology / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011792:Quebec; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left
D000806:Angiotensin-Converting Enzyme Inhibitors