Use of hormone replacement therapy among cardiac patients at a Canadian academic centre

Background: Although hormone replacement therapy (HRT) is associated with a reduced risk of coronary artery disease (CAD), use of this treatment among postmenopausal women is not widespread. The authors sought to determine th e extent of HRT use in a select population of women at high risk for CAD. Methods: A cross-sectional survey was performed involving all consecutive p ostmenopausal women who attended a cardiology clinic in a Toronto teaching hospital between January 1996 and August 1997. A chart review was followed by a telephone interview with the patients or their physicians. The utiliza tion rate of HRT was obtained. Predictors of HRT use were identified using a multivariate logistic regression model. Results: A total of 80 women with risk factors for CAD, symptoms suspicious of CAD or definite CAD diagnosed after cardiac investigations were include d in the I survey. Information on HRT use or nonuse was documented in 17 (2 1%) of the charts. Of the 72 women for whom data on HRT were available 16 ( 22%) were i currently using it, 41 (57%) were not, and 15 (21%) had used it in the past. Five women (7%) were receiving HRT but there was no chart doc umentation. On i multivariate analysis, younger women were more likely than older women to use I HRT (odds ratio 0.91, 95% confidence interval 0.22-0. 96; p < 0.05). Coronary risk profile, CAD diagnosis and history of hysterec tomy were not associated with HRT use. Of the 41 women who had never receiv ed HRT 10 (24%) had possible contraindications (e.g., breast cancer or deep vein thrombosis); the proportion was similar in the group of women who wer e current or past users of HRT (29%). Interpretation: Documentation of HRT use in patient charts is lacking. Few women in the study who were at risk for CAD were currently using HRT. The d ata support the need for better adherence to optimal practices in the manag ement of I women at high risk for CAD.