1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .
2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .
J Womens Health (Larchmt). 2018 May;27(5):623-629. doi: 10.1089/jwh.2017.6461. Epub 2018 Jan 10.
Although heart failure (HF) prevalence is equally high among men and women, observed differences in the provision of care are still not fully understood. We sought to evaluate gender differences in patient profiles, diagnostic testing, medication prescription, and referrals in specialized multidisciplinary ambulatory HF clinics in Ontario.
Medical chart abstraction was conducted first by randomly selecting 9 (out of 34) HF clinics in Ontario, and then by randomly selecting 100 patient records in each clinic. Data on patient demographics, comorbidities, diagnostic tests, medication use, and referrals were abstracted, covering a period from the first clinic visit up to 1 year. Descriptive statistics and regression analysis were used to assess gender differences.
Of the 884 patients, only 314 were women (35.5%). At the first clinic visit, women were older, had better systolic function but worse functional status, and had a lower prevalence of hyperlipidemia, diabetes, and smoking than men. There were more women with non-ischemic HF etiology than men (63.9% vs. 43.3%, p < 0.001). Adjusted analysis did not reveal gender differences in the average number of echocardiographic assessments and in the prescription rates of evidence-based medications. Men were twice more likely to be referred to electrophysiology studies than women (18.6% vs. 7.8%, p < 0.001). The rates of dietary counseling and cardiac rehabilitation referrals were similarly low in both groups.
More men than women are treated in specialized ambulatory HF clinics. Although women differ from men in selected clinical characteristics, no major differences were observed in patient management. The reasons for low enrollment rates of women into the HF ambulatory clinics need further investigation.
尽管心力衰竭（HF）在男性和女性中的患病率相同，但护理提供方面的差异仍未得到充分理解。我们旨在评估安大略省专门的多学科门诊 HF 诊所中患者特征、诊断测试、药物处方和转诊方面的性别差异。
首先通过随机选择安大略省的 9 个（共 34 个）HF 诊所，然后在每个诊所中随机选择 100 份病历，进行病历摘录。摘录的数据包括患者人口统计学、合并症、诊断测试、药物使用和转诊情况，涵盖从第一次就诊到 1 年的时间。使用描述性统计和回归分析评估性别差异。
在 884 名患者中，只有 314 名女性（35.5%）。在第一次就诊时，女性年龄较大，收缩功能较好但功能状态较差，且血脂异常、糖尿病和吸烟的患病率低于男性。女性非缺血性 HF 病因的比例高于男性（63.9% vs. 43.3%，p < 0.001）。调整分析并未显示性别在平均超声心动图评估次数和证据为基础的药物处方率方面存在差异。男性被转诊进行电生理研究的可能性是女性的两倍（18.6% vs. 7.8%，p < 0.001）。膳食咨询和心脏康复转诊的比例在两组中都较低。
在专门的门诊 HF 诊所中，接受治疗的男性多于女性。尽管女性在某些临床特征上与男性不同，但在患者管理方面未观察到明显差异。女性参与 HF 门诊诊所的低参与率的原因需要进一步调查。
