Abstract P188: Quality of Care and Outcomes in Women Hospitalized for Heart Failure
Authors: Klein Liviu , Grau-Sepulveda Maria V , Bonow Robert O , Hernandez Adrian F , Williams Mark V , Bhatt Deepak L , Fonarow Gregg C 
Published: March 2022

Background:
Although women account for a significant portion of the heart failure (HF) hospitalizations, data on the quality of care and in-hospital mortality in women are scarce.

Methods:
We analyzed 99,841 HF admissions from 1/05 to 6/09 at 248 hospitals participating in Get With The Guidelines-HF. Using multivariable logistic or linear regression we assessed the association of sex with HF performance measures [discharge instructions, left ventricular function assessment, ACEI/ARB in LVSD, smoking cessation counseling], length of stay, and in-hospital mortality.

Results:
Women accounted for 50% of HF admissions; they were older (mean age 74 ± 14 vs. 69 ± 14 yrs), more likely to have hypertension (77% vs. 72%), and less likely to have CAD (43% vs. 53%) or renal insufficiency (18% vs. 23%) than men (all p< 0.01). The presenting symptoms were similar to men, but women had higher admission systolic blood pressure (144 ± 31 vs. 137 ± 30 mmHg) and EF (44 ± 17% vs. 34± 16%), both p<0.01. In multivariate analyses, women were less likely than men to have measurement of EF, receive anticoagulation for atrial fibrillation or ICD implant, but as likely to receive instructions, ACEI/ARB, beta-blockers and smoking cessation counseling at discharge (Table). Although the median length or stay was 4 days, women were more likely than men to be hospitalized longer than 4 days (adjusted OR, 1.13; 95% CI, 1.08-1.17) and longer than 7 days (adjusted OR, 1.07; 95% CI, 1.04-1.11).

Conclusions:
Compared to men, women hospitalized for HF have similar characteristics and clinical presentations, received similar quality of care for most but not all measures, and experienced an increased length of stay.

Performance measures and other quality metrics in women compared to men

Measure (% of eligible)
Women
Men
Unadjusted OR
95% CI

Multivariable adjusted OR
*

95% CI

Complete set of written instructions at time of discharge
85
87
0.95
0.92-0.97
0.97
0.94-1.01

Documentation of evaluation of left ventricular function
95
96
0.91
0.88-0.94
0.81
0.76-0.86

ACE - I or ARB prescription for LVSD
89
89
1.01
0.94-1.07
1.03
0.96-1.11

Adult smoking cessation counseling
94
94
1.01
0.94-1.09
1.06
0.95-1.19

Beta-blocker prescription for LVSD
92
93
0.89
0.84-0.95
0.94
0.87-1.03

Warfarin at discharge for patients with atrial fibrillation
59
64
0.85
0.81-0.89
0.91
0.86-0.96

ICD in patients with LVEF ≤ 30% (before admission or placed during admission)
32
45
0.61
0.56-0.67
0.65
0.6-0.7

All-or-none measure (100% compliance with all 5 primary measures)
80
79
1.13
1.1-1.16
0.98
0.95-1.01

*

Multivariable logistic regression of sex effect on performance measures; adjusted for age, race, body mass index, heart rate, systolic blood pressure, ejection fraction, chronic obstructive pulmonary disease, diabetes, prior heart failure, hypertension, dyslipidemia, prior myocardial infarction, peripheral vascular disease, renal insufficiency, stroke, hospital region, number of hospital beds, academic status of hospital.