UK hospitals short-changing women with heart failure

November 13, 2007

Women with heart failure are less likely than men to receive recommended investigations and treatment, when admitted to hospital as an emergency, reveals an extensive UK survey, published ahead of print in the journal Heart.

The findings are based on a survey of almost 9500 patients with heart failure, who were admitted as an emergency to 176 out of 177 acute care hospitals in England, Wales, and Northern Ireland in 2005.

The survey was based on information supplied to the health services watchdog, the Healthcare Commission that year, as part of its national check on acute care services.*

The results indicate that heart failure is being better managed than it was in previous surveys, and that hospital stays for these patients have shortened. But there are still shortcomings.

Deaths from heart failure remain high. Just over half (56%) of those admitted had already been diagnosed with heart failure. And three out of four patients had moderate to severe symptoms on admission, and one in seven (15%) died while in hospital.

Once admitted, only 14% of patients were transferred to the care of a heart specialist.

Half the admissions were women. They tended to be around five years older than the men, and were significantly less likely to have undergone the recommended investigations or been given recommended heart failure treatment.

These included ultrasound scans to detect heart failure (echocardiography), and for those already diagnosed with the condition, drugs, such as ACE inhibitors and beta blockers, despite the strong evidence of the effectiveness of these drugs.

With the exception of diuretics, women remained significantly less likely to be given treatment to prevent worsening of their heart failure when they left hospital, even after having been admitted as an emergency with their condition.

And few patients, irrespective of gender, received all the appropriate recommended care once they had left hospital.

Only one in five patients were given an appointment with a specialist to monitor their progress, and less than 1% were referred to rehabilitation or specialist palliative care.

The authors point out that heart failure will become more common as the population ages and treatment for, and survival from, coronary heart disease continues to improve.

Take up of recommended treatment for heart failure has been slower than for other areas of heart disease, they say..."and significant geographical and gender variation exists in standards of diagnosis, treatment, and care of this progressive and incurable condition."

"Whereas [heart attack], angina and arrhythmia services have clearly defined targets and have been the focus for sustained investment, heart failure still appears to be regarded as a Cinderella subspecialty, despite its ubiquitous nature," they conclude.
-end-


BMJ

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