Equitable improvement for women and men in the use of guideline-recommended therapies for heart failure: findings from IMPROVE HF.
BACKGROUND
Although sex-based disparities in use of guideline-recommended heart failure (HF) therapies have been described, little is known about whether performance improvement (PI) initiatives produce equitable improvements in guideline-recommended therapies.


RESULTS
IMPROVE HF is a prospective study of a practice-based PI intervention in patients with systolic HF or post-myocardial infarction left ventricular dysfunction. Mean changes from baseline to 24 months after intervention were compared between women and men for treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, anticoagulation for atrial fibrillation, cardiac resynchronization therapy (CRT), implantable cardioverter-defibrillator (ICD), and HF education. This analysis included 15,170 patients at 167 cardiology practices (4,383 [28.9%] women, 10,787 [71.1%] men). At baseline, women were less likely than men to be treated with anticoagulation and ICD. Significant improvements in 6 of 7 quality measures were evident at 24 months for both sexes. The absolute magnitude of improvement was similar for 5 measures and significantly better in women for CRT, ICD, and composite care.


CONCLUSIONS
This PI intervention was associated with similar or greater increases in use of guideline-recommended HF therapies for eligible women compared with men. Clinical decision support and performance feedback may help to ensure improved, equitable care for men and women with HF.
St Vincent Heart Center of Indiana, Indianapolis, IN, USA. macwalsh@iquest.net
Mary Norine
MN
Walsh
Clyde W
CW
Yancy
Nancy M
NM
Albert
Anne B
AB
Curtis
Mihai
M
Gheorghiade
J Thomas
JT
Heywood
Patches Johnson
PJ
Inge
Mark L
ML
McBride
Mandeep R
MR
Mehra
Christopher M
CM
O'Connor
Dwight
D
Reynolds
Gregg C
GC
Fonarow
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012737:Sex Factors