Are there age and sex differences in the investigation and treatment of heart failure? A population-based study

Background. Heart failure is a serious, common, and growing problem. Hospit al admissions, which account for the bulk of health service costs associate d with heart failure, are becoming more frequent Aim. To determine whether management of heart failure differs by age and se x. Method. A retrospective case note review of prevalent cases in 16 general p ractices in West London. Five hundred and eighty-three patients (57% women) with a diagnosis of heart failure were reviewed. Results. Mean age of patients with heart failure was 78 years (SD = 9.5) - 74 years at diagnosis (SD = 10) - and was higher for women than men (76 yea rs versus 71 years, P<0.007). In 32% of patients there was no record of a c hest X-ray, electrocardiogram, or echocardiogram to support diagnosis. Echo cardiography, performed in 34% of patients, was less likely in older patien ts in both sexes (test for trend P = 0.04 in women and 0.02 in men) and, ov erall, in women (29% compared with 40% of men, P = 0.006). Angiotensin-conv erting enzyme (ACE) inhibitor treatment, recorded in 54% of patients, decre ased with age in both sexes (P<0.001) and, on unadjusted data, was more lik ely in men than in women (61% compared with 49%, P = 0005). On adjustment f or age, sex differences in the use of echocardiography and ACE inhibitors w ere reduced and no longer significant. Conclusions. With increasing age, men and women with heart failure were les s likely to have undergone echocardiography or to have received an ACE inhi bitor. When account was taken of age, there were no statistically significa nt sex differences in management; however, because of the demographic distr ibution of heart failure, women are disproportionately affected by age diff erences in management. Clinical trials, physician practice, and service dev elopments in heart failure have neglected older people. This balance should be redressed.