EJHF: Gender plays a role in treatment of heart failure patients

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While the treatment of heart failure has improved over the past two decades, the use of evidence-based treatments appears to be imbalanced according to the gender of the patient, according to a study published in the January issue of European Journal of Heart Failure.

In particular, the study found that:

  • Female patients were less frequently treated with guideline-recommended medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs); and
  • Doses were lower in female than in male patients.

Magnus Baumhakel from the University Hospital of the Saarland in Homburg, Germany, and colleagues evaluated 1,857 consecutive patients treated at the centers in Germany; and analyzed treatment records involving 829 physicians (65 percent general practitioners, 27 percent internists and 7 percent cardiologists) with regard to evidence-based drug treatments to improve survival. They calculated an assessment of dosages as a percentage of averages documented in treatment guidelines for heart failure.

The authors said that the patient's gender was not the only influence on treatment; so was the gender of the physician. The study demonstrated for the first time that drug treatment is more complete when female physicians are taking care of the patient. Thus, the use of ACE inhibitors or ARBs was significantly lower in female patients treated by a male physician than in male patients treated by either a female or male physician.

Similarly, the researchers said that the dose of ACE inhibitors and ARBs was highest in male patients treated by female physicians and was significantly different from the reverse combination (female patient, male physician). Dosage of beta-blockers was comparable in male patients irrespective of the physician's gender, whereas female patients treated by a male physician received the lowest doses.

The investigators concluded that “male patients with chronic heart failure are more likely to receive evidence-based drug treatment than female patients,” particular so for the prescription of ACE inhibitors and dosage of beta-blockers.

“The use of evidence-based treatments as described in the latest guidelines has undoubtedly improved the treatment of chronic heart failure. But there is still evidence of a gender imbalance in both patients and physicians. From our results it seems fair to say that the gender of the physician plays an important role in adherence to drug treatment recommendations in chronic heart failure,” Baumhakel said.