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Fluschnik N, Strangl F, Kondziella C, Goßling A, Becher PM, Schrage B, Schnabel RB, Bernadyn J, Bremer W, Grahn H, Bernhardt AM, Reichenspurner H, Rybczynski M, Blankenberg S, Kirchhof P, Magnussen C, Knappe D. Gender differences in characteristics and outcomes in heart failure patients referred for end-stage treatment. ESC Heart Fail 2021; 8:5031-5039. [PMID: 34486813 PMCID: PMC8712844 DOI: 10.1002/ehf2.13567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/04/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022] Open
Abstract
Aims Despite signals from clinical trials and mechanistic studies implying different resilience to heart failure (HF) depending on gender, the impact of gender on presentation and outcomes in patients with HF remains unclear. This study assessed the impact of gender on clinical presentation and outcomes in patients with HF referred to a specialised tertiary HF service. Methods and results Consecutive patients with HF referred to a specialised tertiary HF service offering advanced therapy options including left ventricular assist devices (LVAD) and heart transplantation were prospectively enrolled from August 2015 until March 2018. We assessed clinical characteristics at baseline and performed survival analyses and age‐adjusted Cox regression analyses in men vs. women for all‐cause death and a combined disease‐related endpoint comprising death, heart transplantation, and LVAD implantation. Analyses were performed for the overall study population and for patients with HF with reduced ejection fraction (HFrEF). Of 356 patients included, 283 (79.5%) were male. The median age was 58 years (interquartile range 50–67). Two hundred and fifty‐one (74.5%) patients had HFrEF. HF aetiology, ejection fraction, functional status measures, and most of the cardiac and non‐cardiac comorbidities did not differ between men and women. In a median follow‐up of 3.2 years, 50 patients died (45 men, 5 women), 15 patients underwent LVAD implantation, and 8 patients heart transplantation. While all‐cause death was not significantly different between both genders in the overall population [16.9 vs. 6.0%, P = 0.065, hazard ratio (HR) 2.29 (95% confidence interval 0.91–5.78), P = 0.078], in the HFrEF subgroup, a significant difference between men and women was observed [20.7% vs. 3.9%, P = 0.017, HR 3.67 (95% confidence interval 1.13–11.91), P = 0.031]. The combined endpoint was more often reached in men than in women in both the overall population [21.6% vs. 9.0%, P = 0.053, HR 2.51 (1.08–5.82), P = 0.032] and the HFrEF subgroup [27.1% vs. 7.7%, P = 0.015, HR 3.58 (1.29–9.94), P = 0.014]. Conclusions Patients referred to a specialised tertiary HF service showed a similar clinical profile without relevant gender differences. In the mid‐term follow‐up, more male than female patients died or underwent heart transplantation and LVAD implantation. These findings call for independent validation and for further research into gender‐specific drivers of HF progression.
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Affiliation(s)
- Nina Fluschnik
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Felix Strangl
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Christoph Kondziella
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Julia Bernadyn
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Wiebke Bremer
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Hanno Grahn
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany
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2
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Fowokan A, Frankfurter C, Dobrow MJ, Abrahamyan L, Mcdonald M, Virani S, Harkness K, Lee DS, Pakosh M, Ross H, Grace SL. Referral and access to heart function clinics: A realist review. J Eval Clin Pract 2021; 27:949-964. [PMID: 33020996 DOI: 10.1111/jep.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIM, AND OBJECTIVES Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. METHODS Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full-texts. Relevant data from included articles were used to refine the program theory. RESULTS A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). CONCLUSION Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub-optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.
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Affiliation(s)
| | | | - Mark J Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- St. Paul's Hospital, University of British Columbia, and Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Karen Harkness
- CorHealth Ontario, Toronto, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Douglas S Lee
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- University Health Network, Toronto, Ontario, Canada
| | - Sherry L Grace
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada
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3
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Sullivan K, Doumouras BS, Santema BT, Walsh MN, Douglas PS, Voors AA, Van Spall HG. Sex-Specific Differences in Heart Failure: Pathophysiology, Risk Factors, Management, and Outcomes. Can J Cardiol 2021; 37:560-571. [DOI: 10.1016/j.cjca.2020.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
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Abrahamyan L, Sahakyan Y, Wijeysundera HC, Krahn M, Rac VE. Gender Differences in Utilization of Specialized Heart Failure Clinics. J Womens Health (Larchmt) 2018; 27:623-629. [PMID: 29319404 DOI: 10.1089/jwh.2017.6461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although heart failure (HF) prevalence is equally high among men and women, observed differences in the provision of care are still not fully understood. We sought to evaluate gender differences in patient profiles, diagnostic testing, medication prescription, and referrals in specialized multidisciplinary ambulatory HF clinics in Ontario. MATERIALS AND METHODS Medical chart abstraction was conducted first by randomly selecting 9 (out of 34) HF clinics in Ontario, and then by randomly selecting 100 patient records in each clinic. Data on patient demographics, comorbidities, diagnostic tests, medication use, and referrals were abstracted, covering a period from the first clinic visit up to 1 year. Descriptive statistics and regression analysis were used to assess gender differences. RESULTS Of the 884 patients, only 314 were women (35.5%). At the first clinic visit, women were older, had better systolic function but worse functional status, and had a lower prevalence of hyperlipidemia, diabetes, and smoking than men. There were more women with non-ischemic HF etiology than men (63.9% vs. 43.3%, p < 0.001). Adjusted analysis did not reveal gender differences in the average number of echocardiographic assessments and in the prescription rates of evidence-based medications. Men were twice more likely to be referred to electrophysiology studies than women (18.6% vs. 7.8%, p < 0.001). The rates of dietary counseling and cardiac rehabilitation referrals were similarly low in both groups. CONCLUSIONS More men than women are treated in specialized ambulatory HF clinics. Although women differ from men in selected clinical characteristics, no major differences were observed in patient management. The reasons for low enrollment rates of women into the HF ambulatory clinics need further investigation.
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Affiliation(s)
- Lusine Abrahamyan
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Yeva Sahakyan
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Harindra C Wijeysundera
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,4 Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Murray Krahn
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Valeria E Rac
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,6 Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
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5
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Yen CM, Lin CL, Lin MC, Chen HY, Lu NH, Kao CH. Pneumoconiosis increases the risk of congestive heart failure: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e3972. [PMID: 27336897 PMCID: PMC4998335 DOI: 10.1097/md.0000000000003972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The purpose of the study was to determine the relationship between pneumoconiosis and congestive heart failure (CHF).We collected data from the National Health Insurance Research Database in Taiwan. The study sample comprised 8923 patients with pneumoconiosis and 35,692 nonpneumoconiosis controls enrolled from 2000 to 2011. Patients were followed up until the end of 2011 to evaluate the incidence of CHF. The risk of CHF was analyzed using Cox proportional hazard regression models, and the analysis accounted for factors such as sex, age, comorbidities, and air pollutants (μg/m).The overall incidence of CHF was higher in the pneumoconiosis cohort (15.7 per 1000 person-y) than in the nonpneumoconiosis cohort (11.2 per 1000 person-y), with a crude hazard ratio (HR) of 1.40 (P < 0.001). The HR for CHF was 1.38-fold greater in the pneumoconiosis cohort than in the nonpneumoconiosis cohort (P < 0.001) after the model was adjusted for age, sex, various comorbidities, and air pollutants (μg/m). The relative risk for CHF in the sex-specific pneumoconiosis cohort compared with the nonpneumoconiosis cohort was significant for men (adjusted HR = 1.40, 95% confidence interval = 1.21-1.62, P < 0.001). The incidence density rates of CHF increased with age; pneumoconiosis patients had a higher relative risk of CHF for all age group.Patients with pneumoconiosis were at higher risk for developing CHF than patients in the nonpneumoconiosis cohort, particularly in cases with coexisting coronary artery disease, hypertension, and chronic obstructive pulmonary disease.
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Affiliation(s)
- Chia-Ming Yen
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, I-Shou University, Kaohsiung
| | - Huei-Yong Chen
- Department of Nuclear Medicine, E-DA Hospital, I-Shou University, Kaohsiung
| | - Nan-Han Lu
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung
| | - Chia-Hung Kao
- Department of Nuclear Medicine PET Center, China Medical University Hospital
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Feldman DE, Huynh T, Des Lauriers J, Giannetti N, Frenette M, Grondin F, Michel C, Sheppard R, Montigny M, Lepage S, Nguyen V, Behlouli H, Pilote L. Gender and Other Disparities in Referral to Specialized Heart Failure Clinics Following Emergency Department Visits. J Womens Health (Larchmt) 2013; 22:526-31. [DOI: 10.1089/jwh.2012.4107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Debbie Ehrmann Feldman
- Université de Montréal, Montreal, Quebec, Canada
- Public Health Department of Montreal, Montreal, Quebec, Canada
- Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Thao Huynh
- McGill University Health Centre, Montréal, Québec, Canada
| | | | | | - Marc Frenette
- Hôpital du Sacre Cœur de Montréal, Montréal, Québec, Canada
| | | | | | | | | | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Viviane Nguyen
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Louise Pilote
- McGill University Health Centre, Montréal, Québec, Canada
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Feldman DE, Huynh T, Lauriers JD, Giannetti N, Frenette M, Grondin F, Michel C, Sheppard R, Montigny M, Lepage S, Nguyen V, Behlouli H, Pilote L. Access to heart failure care post emergency department visit: do we meet established benchmarks and does it matter? Am Heart J 2013; 165:725-32. [PMID: 23622909 DOI: 10.1016/j.ahj.2013.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Canadian Cardiology Society recommends that patients should be seen within 2 weeks after an emergency department (ED) visit for heart failure (HF). We sought to investigate whether patients who had an ED visit for HF subsequently consult a physician within the current established benchmark, to explore factors related to physician consultation, and to examine whether delay in consultation is associated with adverse events (AEs) (death, hospitalization, or repeat ED visit). METHODS Patients were recruited by nurses at 8 hospital EDs in Québec, Canada, and interviewed by telephone within 6 weeks of discharge and subsequently at 3 and 6 months. Clinical variables were extracted from medical charts by nurses. We used Cox regression in the analysis. RESULTS We enrolled 410 patients (mean age 74.9 ± 11.1 years, 53% males) with a confirmed primary diagnosis of HF. Only 30% consulted with a physician within 2 weeks post-ED visit. By 4 weeks, 51% consulted a physician. Over the 6-month follow-up, 26% returned to the ED, 25% were hospitalized, and 9% died. Patients who were followed up within 4 weeks were more likely to be older and have higher education and a worse quality of life. Patients who consulted a physician within 4 weeks of ED discharge had a lower risk of AEs (hazard ratio 0.59, 95% CI 0.35-0.99). CONCLUSION Prompt follow-up post-ED visit for HF is associated with lower risk for major AEs. Therefore, adherence to current HF guideline benchmarks for timely follow-up post-ED visit is crucial.
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8
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Gravely S, Ginsburg L, Stewart DE, Mak S, Grace SL. Referral and use of heart failure clinics: what factors are related to use? Can J Cardiol 2012; 28:483-9. [PMID: 22366509 PMCID: PMC4494832 DOI: 10.1016/j.cjca.2011.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/29/2011] [Accepted: 11/29/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Heart failure (HF) clinics have been shown to reduce hospital readmissions and generally have favourable effects on quality of life, survival, and care costs. This study investigated the rates of referral and use of HF clinics and examined factors related to program use. METHODS This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling, and need factors affecting HF clinic use. Then 1 year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. RESULTS Forty-one patients (15.2%) self-reported referral, and 35 (13%) self-reported attending an HF clinic. Generalized estimating equations showed that factors related to greater program use were having an HF clinic at the site of hospital recruitment (odds ratio [OR] = 8.40; P = 0.04), referral to other disease management programs (OR = 4.87; P = 0.04), higher education (OR = 4.61; P = 0.02), lower stress (OR = 0.93; P = 0.03), and lower functional status (OR = 0.97; P = 0.03). CONCLUSION Similar to previous research, only one-seventh of HF patients were referred to and used an HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated.
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Affiliation(s)
- Shannon Gravely
- York University, Faculty of Health, Toronto, Ontario, Canada
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9
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011; 17:540-6. [DOI: 10.1016/j.cardfail.2011.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/01/2011] [Accepted: 03/03/2011] [Indexed: 11/26/2022]
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10
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.03.001
https://www.sciencedirect.com/science/article/pii/s1071916411001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Severity at entry to specialized heart failure clinics: discrepancies between health-related quality of life and function in men and women. Can J Cardiol 2011; 27:382-7. [PMID: 21514784 DOI: 10.1016/j.cjca.2010.12.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 12/02/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We compared severity of heart failure (HF) between men and women at entry to the multidisciplinary HF clinic based on 3 measures: New York Heart Association functional class, norm-referenced 6-minute walk distance, and health-related quality of life. METHODS Newly admitted patients to 1 of 6 HF clinics were enrolled. Data were collected from a clinical database, questionnaires were administered to patients, and tests were administered by clinic nurses. We compared men and women with respect to the 3 severity indicators at entry to the clinic. RESULTS In adjusted analyses, women had a lower health-related quality of life (P = 0.04) but did not have lower norm-referenced 6-minute walk distance or lower New York Heart Association functional class on entry to the clinic. Having more comorbid conditions, being on medication, and having visited the emergency department or been admitted to hospital in the past 6 months were associated with higher severity at entry according to all 3 indicators. CONCLUSIONS Women report a lower health-related quality of life at entry to the clinic, although functional capacity does not seem to differ between women and men. Reasons for these discrepancies will need to be elucidated to better address women's health needs.
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Affiliation(s)
- Debbie Ehrmann Feldman
- University of Montreal, Faculty of Medicine, School of Rehabilitation, and Public Health Department of Montreal, Montreal, Québec, Canada.
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12
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Grace SL, Racco C, Chessex C, Rivera T, Oh P. A narrative review on women and cardiac rehabilitation: Program adherence and preferences for alternative models of care. Maturitas 2010; 67:203-8. [DOI: 10.1016/j.maturitas.2010.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 07/01/2010] [Accepted: 07/03/2010] [Indexed: 12/18/2022]
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The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can J Cardiol 2010; 26:185-202. [PMID: 20386768 DOI: 10.1016/s0828-282x(10)70367-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world - HF in ethnic minorities - and in an uncommon but important setting - the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics - disease management programs in HF and quality assurance - have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada.
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Ehrmann Feldman D, Xiao Y, Bernatsky S, Haggerty J, Leffondré K, Tousignant P, Roy Y, Abrahamowicz M. Consultation with cardiologists for persons with new-onset chronic heart failure: a population-based study. Can J Cardiol 2010; 25:690-4. [PMID: 19960128 DOI: 10.1016/s0828-282x(09)70528-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND It is recommended that persons recently diagnosed with heart failure consult with a specialist in heart failure. OBJECTIVES To determine whether patients who were diagnosed with new-onset chronic heart failure (CHF) by a noncardiologist consulted with a cardiologist, and identify the factors associated with delayed consultation. METHODS Physician reimbursement administrative data were obtained for all adults with suspected new-onset CHF in the year 2000 in Quebec, defined operationally as a physician visit for CHF (based on the International Classification of Diseases, 9th Revision diagnostic codes), with no previous physician visit code for CHF in the preceding three years. Among those first diagnosed by a noncardiologist, Cox regression modelling was used to identify patient and physician characteristics associated with time to cardiology consultation. RESULTS Of the 13,523 persons coded as having incident CHF, 54.9% consulted a cardiologist within the next 2.5 to 3.5 years, and 67.4% were seen by an internist or cardiologist. Older patients, women, and those with lower comorbidity and socioeconomic status had significantly longer times to cardiology consultation. CONCLUSION The data suggest that many patients with suspected new-onset CHF do not receive prompt cardiology care, as stipulated by current recommendations. Equity of access for women and those with lower socioeconomic status appears to be problematic.
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Ehrmann Feldman D, Ducharme A, Frenette M, Giannetti N, Michel C, Grondin F, Sheppard R, Behlouli H, Pilote L. Factors related to time to admission to specialized multidisciplinary clinics in patients with congestive heart failure. Can J Cardiol 2009; 25:e347-52. [PMID: 19812808 DOI: 10.1016/s0828-282x(09)70720-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Congestive heart failure (CHF) is a common cause of hospitalization and has a poor prognosis. Specialized multidisciplinary clinics are effective in the management of CHF. OBJECTIVES To measure time of admission to the specialized clinics and explore factors related to the time of admission to these clinics. METHODS Patients who were newly admitted to one of six CHF multidisciplinary clinics in the province of Quebec were enrolled in the study. Data were collected from the common clinical database used at these clinics as well as from questionnaires administered to the patients. RESULTS A total of 531 patients with a mean age of 65.9 years were enrolled. Only 26% were women. The median duration of disease before admission to the CHF clinic was 1.2 years. The majority of patients (62%) were referred by a cardiologist or an internist, while 24% were referred by other specialists, and 14% by general practitioners. One-fifth of patients did not have regular follow-up for their CHF before being admitted to the clinic. Factors associated with shorter disease duration at admission to the clinic were referral by a specialist, not having regular medical follow-up for CHF, having a higher income and having visited the emergency room for CHF. CONCLUSION There may be a need to improve dissemination of information regarding availability and benefits of CHF clinics and criteria for referral.
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Rouleau DM, Feldman DE, Parent S. Delay to orthopedic consultation for isolated limb injury: cross-sectional survey in a level 1 trauma centre. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2009; 55:1006-7.e75. [PMID: 19826162 PMCID: PMC2761960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation.
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Gustafsson F, Schou M, Videbaek L, Dridi N, Ryde H, Handberg J, Hildebrandt PR. Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics. Eur J Heart Fail 2009; 11:413-9. [DOI: 10.1093/eurjhf/hfp025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Finn Gustafsson
- Department of Cardiology B; The Heart Centre, Rigshospitalet; Blegdamsvej 9 DK-2100 Copenhagen Denmark
| | - Morten Schou
- Department of Cardiology and Endocrinology; Frederiksberg Hospital; Frederiksberg Denmark
| | - Lars Videbaek
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Nadia Dridi
- Department of Internal Medicine; Amager Hospital; Copenhagen Denmark
| | - Henrik Ryde
- Department of Internal Medicine; Slagelse Sygehus; Slagelse Denmark
| | - Jens Handberg
- Department of Cardiology and Endocrinology Hillerød Sygehus; Hillerød Denmark
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