Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: Findings from IMPROVE HF

Background The influence of patient age and sex on delivery of guideline-recommended heart failure (HF) therapies in contemporary outpatient settings has not been well studied. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is a prospective cohort study designed to characterize current management of outpatients with chronic HF and left ventricular ejection fraction <= 35%. Methods Baseline data for eligible patients with systolic HF in a national registry of 167 US outpatient cardiology practices were collected by trained chart abstractors. Data were stratified and analyzed as male/female and by age tertiles with generalized estimating equation models constructed for 7 care measures. Results A total of 15,381 patients were enrolled, with 8,770 (71.1%) of these male. Median age of female patients was 72.0 and 70.0 for males. Use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, aldosterone inhibitors, and cardiac resynchronization therapy was not significantly different between male and female patients, but rates for implantable cardioverter defibrillators, anticoagulation therapy for atrial fibrillation, and HIF education were significantly lower for females. After adjusting for patient and practice characteristics, 3 of 7 measures significantly differed by patient sex, and 6 of 7 measures by age. Older patients, particularly older women, were significantly less likely to receive guideline-indicated HIF therapies. Conclusions Patient age and sex were independently associated with reduced rates of some, but not all, HIF therapies in outpatient cardiology practices. Older women are especially at risk. Further research is needed to understand the causes and consequences of these age- and sex-related differences in care. (Am Heart J 2009; 157:754-62.)