title: Quality of care and outcomes in women hospitalized for heart failure.
abstract: BACKGROUND
  Although women account for a significant proportion of heart failure (HF) hospitalizations, data on the quality of care and in-hospital outcomes in women are limited.
  
  
  RESULTS
  We examined The Joint Commission performance measures, other quality metrics, length of stay, and in-hospital mortality in women using 99 841 HF admissions (January 2005 to June 2009) at 248 hospitals participating in the American Heart Association Get With The Guidelines-Heart Failure registry. Women accounted for 50% of the HF admissions and were older (mean age, 74±14 versus 69±14 years), more likely to have hypertension (77% versus 72%), and less likely to have coronary disease (44% versus 53%) or renal insufficiency (18% versus 23%) than men (all P<0.001). The presenting symptoms were similar to men, but women had higher admission systolic blood pressure (mean, 144±31 versus 137±30 mm Hg; P<0.001) and ejection fraction (mean, 0.44±0.17% versus 0.34±0.16%; P<0.001). After adjustment for baseline differences, eligible women were less likely than men to have measurement of left ventricular function (adjusted odds ratio [OR], 0.81; 95% CI, 0.76 to 0.86) and to receive anticoagulation for atrial fibrillation (adjusted OR, 0.91; 95% CI, 0.86 to 0.96) or implantable cardioverter-defibrillators (adjusted OR, 0.70; 95% CI, 0.65 to 0.75) but were as likely to receive discharge instructions, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and smoking cessation counseling at discharge. Although the median length of stay was 4 days, women were more likely than men to be hospitalized >4 days (adjusted OR, 1.13; 95% CI, 1.10 to 1.16) and >7 days (adjusted OR, 1.07; 95% CI, 1.04 to 1.11). Women had comparable in-hospital mortality to men (adjusted OR, 1.05; 95% CI, 0.96 to 1.14).
  
  
  CONCLUSIONS
  Compared to men, women hospitalized for HF differ in many clinical characteristics and length of stay but have similar clinical presentations, receive similar quality of care for most but not all measures, and experience similar in-hospital mortality.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA. lklein@northwestern.edu
authors.forename: Liviu
authors.initials: L
authors.lastname: Klein
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D000925:Anticoagulants / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants