Diagnostic tests, treatment and follow-up in heart failure patients - is there a gender bias in the coherence to guidelines?

Aims: To relate clinical data in a consecutive cohort of patients admitted with heart failure in Sweden to demographic data and the use of diagnostic tests, medical treatment, care process and mortality. Methods and results: Retrospective investigation of all charts concerning patients discharged wi th primary diagnosis of heart failure in two Swedish hospitals during the s econd half of 1995 was undertaken. Records from 187 men and 192 women were analyzed, median age was 78 years. During hospital stay 75% of the patients , regardless of gender, were examined with chest radiography. Echocardiogra phy was performed in 59% of all patients, more often in men than in women ( 68% vs. 55%, P < 0.011). The proportion of patients receiving ACE-inhibitor s was higher if echocardiography had been performed, in both men (38% vs. 7 2%, P < 0.001) and women (38% vs. 55%, P < 0.033). Mean hospital stay was 6 .4 days. After discharge 57% of the patients were referred to the general p ractitioners (GP), 21% to the hospital outpatient clinic. Young age (P < 0. 001), male gender (P < 0.01) and treatment with P-blocking agents (P < 0.03 5) were independently related to referral to hospital outpatient clinic. Wi thin the group referred to the GPs, 62% of the patients had a follow-up vis it within 3 months after discharge while 49% had visited the hospital outpa tient clinic. The 1-year mortality rate was high, 30%. Conclusion: Patients admitted with heart failure in Sweden are old and carry a poor prognosis. In spite of the poor prognosis, only approximately half of the patients are followed-up within 3 months after discharge. There is, in contrast to prac tice guidelines, an underuse of diagnostic tests of left ventricular functi on and medical treatment is often suboptimal. These unsatisfactory findings were more pronounced in women. (C) 1999 European Society of Cardiology. Al l rights reserved.