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Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF.
Am Heart J. 2009 Apr; 157(4):754-62.e2.AH

Abstract

BACKGROUND

The influence of patient age and sex on delivery of guideline-recommended heart failure (HF) therapies in contemporary outpatient settings has not been well studied. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is a prospective cohort study designed to characterize current management of outpatients with chronic HF and left ventricular ejection fraction < or =35%.

METHODS

Baseline data for eligible patients with systolic HF in a national registry of 167 US outpatient cardiology practices were collected by trained chart abstractors. Data were stratified and analyzed as male/female and by age tertiles with generalized estimating equation models constructed for 7 care measures.

RESULTS

A total of 15,381 patients were enrolled, with 8,770 (71.1%) of these male. Median age of female patients was 72.0 and 70.0 for males. Use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, aldosterone inhibitors, and cardiac resynchronization therapy was not significantly different between male and female patients, but rates for implantable cardioverter defibrillators, anticoagulation therapy for atrial fibrillation, and HF education were significantly lower for females. After adjusting for patient and practice characteristics, 3 of 7 measures significantly differed by patient sex, and 6 of 7 measures by age. Older patients, particularly older women, were significantly less likely to receive guideline-indicated HF therapies.

CONCLUSIONS

Patient age and sex were independently associated with reduced rates of some, but not all, HF therapies in outpatient cardiology practices. Older women are especially at risk. Further research is needed to understand the causes and consequences of these age- and sex-related differences in care.

Authors+Show Affiliations

Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX 75246, USA. clydey@baylorhealth.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19332206

Citation

Yancy, Clyde W., et al. "Influence of Patient Age and Sex On Delivery of Guideline-recommended Heart Failure Care in the Outpatient Cardiology Practice Setting: Findings From IMPROVE HF." American Heart Journal, vol. 157, no. 4, 2009, pp. 754-62.e2.
Yancy CW, Fonarow GC, Albert NM, et al. Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Am Heart J. 2009;157(4):754-62.e2.
Yancy, C. W., Fonarow, G. C., Albert, N. M., Curtis, A. B., Stough, W. G., Gheorghiade, M., Heywood, J. T., McBride, M. L., Mehra, M. R., O'Connor, C. M., Reynolds, D., & Walsh, M. N. (2009). Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. American Heart Journal, 157(4), 754-e2. https://doi.org/10.1016/j.ahj.2008.12.016
Yancy CW, et al. Influence of Patient Age and Sex On Delivery of Guideline-recommended Heart Failure Care in the Outpatient Cardiology Practice Setting: Findings From IMPROVE HF. Am Heart J. 2009;157(4):754-62.e2. PubMed PMID: 19332206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. AU - Yancy,Clyde W, AU - Fonarow,Gregg C, AU - Albert,Nancy M, AU - Curtis,Anne B, AU - Stough,Wendy Gattis, AU - Gheorghiade,Mihai, AU - Heywood,J Thomas, AU - McBride,Mark L, AU - Mehra,Mandeep R, AU - O'Connor,Christopher M, AU - Reynolds,Dwight, AU - Walsh,Mary Norine, PY - 2008/10/22/received PY - 2008/12/29/accepted PY - 2009/4/1/entrez PY - 2009/4/1/pubmed PY - 2009/4/22/medline SP - 754 EP - 62.e2 JF - American heart journal JO - Am Heart J VL - 157 IS - 4 N2 - BACKGROUND: The influence of patient age and sex on delivery of guideline-recommended heart failure (HF) therapies in contemporary outpatient settings has not been well studied. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is a prospective cohort study designed to characterize current management of outpatients with chronic HF and left ventricular ejection fraction < or =35%. METHODS: Baseline data for eligible patients with systolic HF in a national registry of 167 US outpatient cardiology practices were collected by trained chart abstractors. Data were stratified and analyzed as male/female and by age tertiles with generalized estimating equation models constructed for 7 care measures. RESULTS: A total of 15,381 patients were enrolled, with 8,770 (71.1%) of these male. Median age of female patients was 72.0 and 70.0 for males. Use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, aldosterone inhibitors, and cardiac resynchronization therapy was not significantly different between male and female patients, but rates for implantable cardioverter defibrillators, anticoagulation therapy for atrial fibrillation, and HF education were significantly lower for females. After adjusting for patient and practice characteristics, 3 of 7 measures significantly differed by patient sex, and 6 of 7 measures by age. Older patients, particularly older women, were significantly less likely to receive guideline-indicated HF therapies. CONCLUSIONS: Patient age and sex were independently associated with reduced rates of some, but not all, HF therapies in outpatient cardiology practices. Older women are especially at risk. Further research is needed to understand the causes and consequences of these age- and sex-related differences in care. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19332206/Influence_of_patient_age_and_sex_on_delivery_of_guideline_recommended_heart_failure_care_in_the_outpatient_cardiology_practice_setting:_findings_from_IMPROVE_HF_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00002-7 DB - PRIME DP - Unbound Medicine ER -