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Intended for Healthcare Professionals
British Journal of General Practice

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Research Article

Are there age and sex differences in the investigation and treatment of heart failure? A population-based study.

S Hood, S Taylor, A Roeves, A M Crook, P Tlusty, J Cohen, S Kaddoura and H Hemingway
British Journal of General Practice 2000; 50 (456): 559-563.
S Hood
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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S Taylor
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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A Roeves
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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A M Crook
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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P Tlusty
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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J Cohen
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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S Kaddoura
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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H Hemingway
Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London.
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Abstract

BACKGROUND: Heart failure is a serious, common, and growing problem. Hospital admissions, which account for the bulk of health service costs associated with heart failure, are becoming more frequent. AIM: To determine whether management of heart failure differs by age and sex. METHOD: A retrospective case note review of prevalent cases in 16 general practices in West London. Five hundred and eighty-three patients (57% women) with a diagnosis of heart failure were reviewed. RESULTS: Mean age of patients with heart failure was 78 years (SD = 9.5)--74 years at diagnosis (SD = 10)--and was higher for women than men (76 years versus 71 years, P < 0.001). In 32% of patients there was no record of a chest X-ray, electrocardiogram, or echocardiogram to support diagnosis. Echocardiography, performed in 34% of patients, was less likely in older patients in both sexes (test for trend P = 0.04 in women and 0.02 in men) and, overall, in women (29% compared with 40% of men, P = 0.006). Angiotensin-converting enzyme (ACE) inhibitor treatment, recorded in 54% of patients, decreased with age in both sexes (P < 0.001) and, on unadjusted data, was more likely in men than in women (61% compared with 49%, P = 0.005). On adjustment for age, sex differences in the use of echocardiography and ACE inhibitors were reduced and no longer significant. CONCLUSIONS: With increasing age, men and women with heart failure were less likely to have undergone echocardiography or to have received an ACE inhibitor. When account was taken of age, there were no statistically significant sex differences in management; however, because of the demographic distribution of heart failure, women are disproportionately affected by age differences in management. Clinical trials, physician practice, and service developments in heart failure have neglected older people. This balance should be redressed.

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British Journal of General Practice: 50 (456)
British Journal of General Practice
Vol. 50, Issue 456
July 2000
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Are there age and sex differences in the investigation and treatment of heart failure? A population-based study.
S Hood, S Taylor, A Roeves, A M Crook, P Tlusty, J Cohen, S Kaddoura, H Hemingway
British Journal of General Practice 2000; 50 (456): 559-563.

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Are there age and sex differences in the investigation and treatment of heart failure? A population-based study.
S Hood, S Taylor, A Roeves, A M Crook, P Tlusty, J Cohen, S Kaddoura, H Hemingway
British Journal of General Practice 2000; 50 (456): 559-563.
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Print ISSN: 0960-1643
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