The care of elderly women with congestive heart failure at a specialized heart function clinic

Abstract

Background: Women are frequently under-represented in heart failure trials. There are speculations that the care of elderly women might be compromised by physician bias towards a more conservative approach in elderly women who are perceived to be fragile. Objectives: This study was designed to assess the morbidity and mortality of elderly women followed up at a heart function clinic and compare these outcomes to those of the rest of general heart function clinic population. We sought to determine whether differences existed in investigations and management between elderly women and all other patiens. Methods: Patients from the Heart Failure Clinic Registry were used for analysis. Elderly women were defined as 65 yrs of age or older. All 432 patients where followed up from January 1, 2003 until December, 31, 2003. Results: There were 306 male patients (71%) and 125 female patients (29%). 150 men were older than 65 years (35%), and 69 women were older than 65 years (16%). Compared to the rest of population, elderly women had a similar etiology of Heart Failure (ischemic vs. non-ischemic: 41% vs. 59%; P 0.3). Elderly women had more comorbidities in form of history of Hypertension (88% vs. 74% P 0.05), diabetes (27% vs. 24% P .001) and anemia (87% vs. 57% P .001). Elderly women had no statistically significant difference in their utilization of echocardiography (43% vs. 39% P 0.504), Persantine myoview (10% vs. 17% P 0.207), or angiography (5.8% vs. 8.6%; P 0.603). They had a lower utilization rate for a MUGA scan (52% vs. 74%; P 0.001). Elderly women received less ACE-I (77% vs. 88% P 0.019) and less Beta Blocker therapy (62% VS. 84% P 0.001). There was no statistical difference in ER visits (9% vs.10%; P 0.823), or hospital admissions (27% vs. 30%; P 0.660) between elderly women and the rest of our population. The overall mortality of elderly women was 4.4%, compared to 7.7% in the overall population. This difference was not statistically significant, but with a larger population it might hold clinical significance. Conclusion: Elderly women represent a significant proportion of all patients managed in a heart function clinic. They have more co-morbidities than the average heart function clinic patient. Although there are no significant differences in clinical investigations, elderly women are treated significantly less frequently with beta blockers and ACE inhibitors. Further studies are needed to elucidate these important discrepancies in clinical management. 406