Equitable Improvement for Women and Men in the Use of Guideline-Recommended Therapies for Heart Failure: Findings From IMPROVE HF

Abstract

Background Although sex-based disparities in use of guideline-recommended heart failure (HF) therapies have been described, little is known about whether performance improvement (PI) initiatives produce equitable improvements in guideline-recommended therapies. Methods and Results IMPROVE HF is a prospective study of a practice-based PI intervention in patients with systolic HF or post–myocardial infarction left ventricular dysfunction. Mean changes from baseline to 24 months after intervention were compared between women and men for treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, anticoagulation for atrial fibrillation, cardiac resynchronization therapy (CRT), implantable cardioverter-defibrillator (ICD), and HF education. This analysis included 15,170 patients at 167 cardiology practices (4,383 [28.9%] women, 10,787 [71.1%] men). At baseline, women were less likely than men to be treated with anticoagulation and ICD. Significant improvements in 6 of 7 quality measures were evident at 24 months for both sexes. The absolute magnitude of improvement was similar for 5 measures and significantly better in women for CRT, ICD, and composite care. Conclusions This PI intervention was associated with similar or greater increases in use of guideline-recommended HF therapies for eligible women compared with men. Clinical decision support and performance feedback may help to ensure improved, equitable care for men and women with HF. Clinical Trial Registration Information http://www.clinicaltrials.gov unique identifier: NCT00303979.