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Abrahamyan L, Sahakyan Y, Wijeysundera HC, Krahn M, Rac VE. Gender Differences in Utilization of Specialized Heart Failure Clinics. J Womens Health (Larchmt) 2018; 27:623-629. [PMID: 29319404 DOI: 10.1089/jwh.2017.6461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although heart failure (HF) prevalence is equally high among men and women, observed differences in the provision of care are still not fully understood. We sought to evaluate gender differences in patient profiles, diagnostic testing, medication prescription, and referrals in specialized multidisciplinary ambulatory HF clinics in Ontario. MATERIALS AND METHODS Medical chart abstraction was conducted first by randomly selecting 9 (out of 34) HF clinics in Ontario, and then by randomly selecting 100 patient records in each clinic. Data on patient demographics, comorbidities, diagnostic tests, medication use, and referrals were abstracted, covering a period from the first clinic visit up to 1 year. Descriptive statistics and regression analysis were used to assess gender differences. RESULTS Of the 884 patients, only 314 were women (35.5%). At the first clinic visit, women were older, had better systolic function but worse functional status, and had a lower prevalence of hyperlipidemia, diabetes, and smoking than men. There were more women with non-ischemic HF etiology than men (63.9% vs. 43.3%, p < 0.001). Adjusted analysis did not reveal gender differences in the average number of echocardiographic assessments and in the prescription rates of evidence-based medications. Men were twice more likely to be referred to electrophysiology studies than women (18.6% vs. 7.8%, p < 0.001). The rates of dietary counseling and cardiac rehabilitation referrals were similarly low in both groups. CONCLUSIONS More men than women are treated in specialized ambulatory HF clinics. Although women differ from men in selected clinical characteristics, no major differences were observed in patient management. The reasons for low enrollment rates of women into the HF ambulatory clinics need further investigation.
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Affiliation(s)
- Lusine Abrahamyan
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Yeva Sahakyan
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Harindra C Wijeysundera
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,4 Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Murray Krahn
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Valeria E Rac
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,6 Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
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