Are Patient Age and Gender Associated with Delivery of Recommended HF Therapies?

Abstract

Introduction: The association of patient age and/or gender with the delivery of indicated HF therapies in the outpatient setting has not been well studied. Methods: IMPROVE HF is a prospective cohort study designed to characterize the current management of outpatients with chronic systolic HF in a registry and evaluate the effect of practice-specific performance-improvement interventions on the quality of care. Baseline performance data in eligible patients was collected by trained chart abstractors. Data were stratified and analyzed as male/female and by age tertiles. Comparisons were analyzed using Pearson chi-square. Results: 131 cardiology practices are enrolled with data abstracted for 12331 patients. Of these, 8770 (71.1%) of patients are male. Median patient age among female patients is 72.0 years and 70.0 among males. Median LVEF was 25.0%. ACEI, ARB, BB and CRT use were not significantly different between male and female patients, but ICD, anticoagulation for A-fib, and HF education were reduced among eligible female patients. Older patients were significantly less likely to receive most guideline-indicated HF therapies (Table). Conclusions: Both patient age and gender independently significantly influenced delivery of some but not other HF therapies in the outpatient arena. Practice-specific performance-improvement initiatives may close the age and gender treatment gap and improve overall quality of HF care.Tabled 1Influence of Age and Gender on HF Quality of CareMaleFemale≤ 64 years64 < Age ≤ 76> 76 yearsPerformance Measure(n = 8770)(n = 3551)P Value(n = 4217)(n = 4115)(n = 3862)P ValueACEI/ARB %79.578.30.16784.380.272.3< 0.001ß Blocker %84.785.40.38189.285.080.4< 0.001∗Aldo Antag %33.937.20.19145.231.126.5< 0.001Anticoag for A-fib%70.664.80.00471.270.067.40.204∗CRT-P/CRT-D %38.638.10.89338.941.835.10.160∗ICD/CRT-D %53.043.1< 0.00151.555.742.6< 0.001HF Education %61.959.70.02665.260.258.0< 0.001∗Inclusion requires documentation of NYHA class/functional status. The number of eligible patients for these measures may be substantially larger and conformity rates lower as a result of incomplete documentation of NYHA class. Open table in a new tab ∗Inclusion requires documentation of NYHA class/functional status. The number of eligible patients for these measures may be substantially larger and conformity rates lower as a result of incomplete documentation of NYHA class.