Key result
Women hospitalized for heart failure had comparable in-hospital mortality to men (adjusted OR 1.05; 95% CI 0.96-1.14), despite being less likely to receive certain quality of care measures.
Why the study?
Does female sex affect the quality of care and in-hospital outcomes in patients hospitalized for heart failure?
Observational (n=99,841)
Yes
Does female sex affect the quality of care and in-hospital outcomes in patients hospitalized for heart failure?
Women hospitalized for heart failure have similar in-hospital mortality to men and receive similar quality of care for most measures, though they are less likely to have LV function measured or receive ICDs.
Answers are grounded in this paper and cite their sources.
Comparable in-hospital mortality suggests no acute survival disparity by sex in HF; leaves open whether quality gaps affect longer-term outcomes.
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. METHODS AND 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.
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Klein et al. (2011) conducted an observational in Heart failure (n=99,841). Female sex vs. Male sex was evaluated on In-hospital mortality (adjusted OR 1.05, 95% CI 0.96 to 1.14). Women hospitalized for heart failure had comparable in-hospital mortality to men (adjusted OR 1.05; 95% CI 0.96-1.14), despite being less likely to receive certain quality of care measures.
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