St Vincent Heart Center of Indiana, Indianapolis, IN, USA.
J Card Fail. 2010 Dec;16(12):940-9. doi: 10.1016/j.cardfail.2010.07.250.
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.
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.
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.
尽管已经描述了基于性别的心力衰竭（HF）治疗指南推荐使用方面的差异，但对于绩效改进（PI）计划是否会公平地改善指南推荐的治疗方法知之甚少。
改善 HF 是一项针对基于实践的 PI 干预的前瞻性研究，涉及收缩性 HF 或心肌梗死后左心室功能障碍患者。在干预后 24 个月，比较了女性和男性在接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、醛固酮拮抗剂、心房颤动抗凝、心脏再同步治疗（CRT）、植入式心脏复律除颤器（ICD）和 HF 教育治疗方面的平均变化。该分析包括 167 个心脏病学实践中的 15170 名患者（4383 名[28.9%]女性，10787 名[71.1%]男性）。基线时，女性接受抗凝和 ICD 治疗的可能性低于男性。在 24 个月时，两性在 7 项质量指标中的 6 项均有明显改善。5 项措施的改善幅度相当，而 CRT、ICD 和综合护理方面女性的改善幅度明显更大。
该 PI 干预与合格女性相比，男性使用指南推荐的 HF 治疗方法的增加幅度相似或更大。临床决策支持和绩效反馈可能有助于确保 HF 男性和女性获得改善且公平的护理。
