title: Gender and other disparities in referral to specialized heart failure clinics following emergency department visits.
abstract: BACKGROUND
  Persons with heart failure (HF) at high risk for adverse events should be followed by specialized HF clinics, since follow-up by specialized HF clinics improves outcomes for HF patients. The objective was to determine whether there were disparities for gender and other factors associated with referral of patients to specialized HF clinics.
  
  
  METHODS
  In this prospective cohort study, patients with a confirmed primary diagnosis of HF were recruited by nurses at 8 hospital emergency departments (ED) in Québec, Canada. They were interviewed by telephone at 6 weeks post ED discharge and subsequently at 3 months and 6 months. Pertinent clinical variables were extracted from medical charts by trained nurses. Bivariate analysis and multiple logistic regression were used to identify whether gender and other potential factors were associated with referral to the HF clinic.
  
  
  RESULTS
  We enrolled 549 patients (mean age 75.5±11.0 years; 51% males). By 6 months after their ED visit for HF, 37.6% of the cohort were referred to specialized HF clinics. Men were more likely to be referred (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.12, 3.74). Other factors associated with referral were younger age (OR 0.95; 95% CI 0.92, 0.98), and systolic dysfunction HF (left ventricle ejection fraction <40%) (OR 3.08; 95% CI 1.77, 5.46).
  
  
  CONCLUSIONS
  There are disparities in referral with respect to gender, age, and type of HF. These disparities in referral need to be addressed.
authors.affiliation: Université de Montréal, Montreal, Quebec H3C3J7, Canada. debbie.feldman@umontreal.ca
authors.forename: Debbie Ehrmann
authors.initials: DE
authors.lastname: Feldman
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.forename: Julie
authors.initials: J
authors.lastname: Des Lauriers
authors.forename: Nadia
authors.initials: N
authors.lastname: Giannetti
authors.forename: Marc
authors.initials: M
authors.lastname: Frenette
authors.forename: François
authors.initials: F
authors.lastname: Grondin
authors.forename: Caroline
authors.initials: C
authors.lastname: Michel
authors.forename: Richard
authors.initials: R
authors.lastname: Sheppard
authors.forename: Martine
authors.initials: M
authors.lastname: Montigny
authors.forename: Serge
authors.initials: S
authors.lastname: Lepage
authors.forename: Viviane
authors.initials: V
authors.lastname: Nguyen
authors.forename: Hassan
authors.initials: H
authors.lastname: Behlouli
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors