Does gender bias exist in the medical management of heart failure?

Introduction: The purpose of this study was to ascertain the presence of ge nder bias in the medical management of heart failure, and to assess its ass ociation with the specialty of the caregiver physician. Methods: In 309 pat ients with documented left ventricular systolic dysfunction (ejection fract ion <45%) and at least one hospitalization for heart failure, we assessed t he frequency of use of effective medical therapy for heart failure among ma le (n=187) and female (n=122) patients at the time of hospital discharge. W e constructed multivariate models relating patient Sender and caregiver spe cialty to utilization of each class of medications (angiotensin-converting enzyme inhibitors, effective vasodilator therapy (i.e., angiotensin-convert ing enzyme inhibitors or hydralazine-nitrate therapy), diuretics, digoxin), and combination therapy (i.e., vasodilator plus diuretic plus digoxin). Re sults: In crude analyses, we did not find any difference in utilization of medications between male and female patients. Multivariate analyses involvi ng adjustment for age, race, coronary artery disease, ejection fraction, an d other relevant variables, revealed higher utilization of combination ther apy by cardiologists in male versus female patients (adjusted odds ratios=2 .07; 95%CI=1.09-3.95), and higher utilization of digoxin therapy by non-car diologists in female versus male patients (adjusted odds ratio=5.5; 95%CI=1 .4-22.2). No gender or caregiver specialty differences were seen in models relating to the other classes of medications. Conclusions: Our findings sug gest the presence of gender bias in the medical management of heart failure , and identify an interesting interaction between caregiver specialty and g ender bias. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.