Quality of Care and Outcomes in Women Hospitalized for Heart Failure
Background—Although women account for a significant proportion of heart failure (HF) hospitalizations, data on the quality of care and in-hospital outcomes in women are limited.
Methods and Results—We examined Joint Commission performance measures, other quality metrics, length of stay, and in-hospital mortality in women using 99,841 HF admissions (1/05-6/09) at 248 hospitals participating in the American Heart Association's Get With The Guidelines-HF registry. Women accounted for 50% of the HF admissions; they were older (mean age 74±14 vs. 69±14 years), more likely to have hypertension (77% vs. 72%) and less likely to have coronary disease (44% vs. 53%) or renal insufficiency (18% vs. 23%) than men (all p<0.001). The presenting symptoms were similar to men, but women had higher admission systolic blood pressure (mean 144±31 vs. 137±30 mmHg) and ejection fraction (mean 0.44±0.17 vs. 0.34±0.16) (both, p<0.001). After adjustment for baseline differences, eligible women were less likely than men to have measurement of LV function (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86), receive anticoagulation for atrial fibrillation (adjusted OR, 0.91; 95% CI, 0.86-0.96) or implantable cardioverter defibrillators (adjusted OR, 0.70; 95% CI, 0.65-0.75), but as likely to receive discharge instructions, angiotensin converting enzyme inhibitors/ angiotensin receptor blockers, beta-blockers and smoking cessation counseling at discharge. Although the median length of stay was 4 days, women were more likely than men to be hospitalized longer than 4 days (adjusted OR, 1.13; 95% CI, 1.10-1.16) and longer than 7 days (adjusted OR, 1.07; 95% CI, 1.04-1.11). Women had a comparable in-hospital mortality compared to men (adjusted OR, 1.05, 95% CI, 0.96-1.14).
Conclusions—Compared to men, women hospitalized for HF differ in many clinical characteristics and length of stay, but have similar clinical presentations, receive similar quality of care for most but not all measures, and experience similar in-hospital mortality.
- Received December 5, 2010.
- Accepted June 14, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited