title: Gender differences in statin prescription rates, adequacy of dosing, and association of statin therapy with outcome after heart failure hospitalization: a retrospective analysis in a community setting.
abstract: OBJECTIVE
  The existence of gender differences in the management of statin therapy among patients with chronic heart failure (HF) is still poorly investigated. We aimed at exploring the effect of gender on statin prescription rates and adequacy of dosing and on the association between statin therapy and all-cause 1-year mortality, after HF hospitalization in a community setting.
  
  
  METHODS
  Statin prescription rates, adequacy of dosing (estimated as a PDD/DDD ratio >0.80), and 1-year mortality were retrospectively assessed in 2088 consecutive patients discharged from 5 local community hospitals with a definite diagnosis of HF after a mean length of stay of 7.6 days. The effect of gender was explored using multivariable logistic and Cox analyses adjusting to confounders.
  
  
  RESULTS
  Women showed a lower statin prescription rate (25.7 vs 35.3%, P < 0.0001) and a lower prevalence of adequate statin dose (32.6 vs 42.3%, P < 0.0001) than men. Female gender was independently associated with a 24% lower probability of statin prescription and a 48% higher probability of inadequate statin dose. Statin prescription and adequacy of dosing were associated with 35 and 44% decreases in the risk of 1-year mortality, respectively, irrespective of gender. A nested case/control analysis confirmed that adequate statin dose was associated with 48% lower 1-year mortality, again without interaction with gender.
  
  
  CONCLUSIONS
  In patients with chronic HF, female gender is independently associated with lower statin prescription rates and higher probability of inadequate dose. Statin therapy in these subjects is associated with improved 1-year survival in both men and women. This prognostic benefit is not affected by gender.
authors.affiliation: Cardiology Unit - S. Maria Annunziata Hospital, Florence, Italy. pcballo@tin.it.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.affiliation: Epidemiology Unit - Local Health Unit, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.affiliation: Institute for Oncological Studies and Prevention, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.affiliation: Sanitary Direction - Local Health Unit, Pistoia, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Turco
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Franconi
authors.affiliation: Regional Health Agency of Tuscany, Florence, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Zuppiroli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Gender; Heart failure; Prescriptions; Statins; Survival