Heath Care Use Before Incident HF Hospitalization: Women Are More Vulnerable And Less Investigated Than Men

Abstract

<h3>Introduction</h3> Patients consult physicians multiple times before their incident acute heart failure (HF) hospitalization. These health care contacts may represent missed opportunities to prevent hospitalizations. <h3>Objective</h3> The objective of this study was to describe differences between sexes in health care contacts in patients ultimately hospitalized for incident HF. <h3>Methods</h3> We examined the events leading to an incident HF hospitalization, comparing sexes, in a retrospective population-based study including a matched non-HF control group. The rate of health care contacts in the year preceding index HF hospitalization, as well specialist referrals and cardiac investigations were examined. We used a multivariable negative binomial regression model for repeated events to evaluate the impact of sex on health care contacts preceding HF hospitalization. <h3>Results</h3> A total of 55,743 adults were hospitalized with <i>de novo</i> HF, of which 51.4% were women. Women were significantly older and also more likely to live in a socio-economically deprived neighborhood, receive home care services, and live in a long-term care facility (p<0.001). Both women and men with HF had a higher rate of health care contacts compared to population controls. In both sexes, the rate increased exponentially before their incident HF hospitalization (Figure 1), although the rate was marginally lower in women (RR 0.98, 95% CI: 0.97-0.99; p<0.001). Women had fewer specialist referral and procedures performed despite having a greater number of physician visits than men (Table 1). <h3>Conclusions</h3> Missed opportunities to prevent HF hospitalization are observed in both sexes, but women have significantly less access to cardiac diagnostic investigations. Our study suggests differential care patterns before the first HF episode according to sex. This may reflect a lower index of suspicion of HF amongst women and could represent an education opportunity.