A woman who suffers from heart failure is less likely to get the recommended investigations and treatment than a man when she is admitted to hospital as an emergency, according to an article published in the journal Heart (British Medical Journal).
The findings come after analysis of a survey involving nearly 9,500 heart failure patients. They were all admitted as an emergency in 176 out of 177 acute care hospitals in England, Wales and Northern Ireland in 2005.
The information for this survey came from the Healthcare Commission, the health services watchdog, as part of its national check on acute care services.*
The indications are that there is better management of heart failure now than in the past, and that patients are staying in hospital for shorter periods. However, failings still exist.
The death rate from heart failure is still high. 15% of heart failure patients died while still in hospital. 56% of patients admitted had previously been diagnosed with heart failure. 75% of patients had moderate/severe symptoms on admission to hospital. Only 14% of patients who were admitted were transferred to the care of a heart specialist.
Approximately 50% of those admitted were women. In general, they were about five years older than the men. The researchers comment that they were much less likely to have undergone the recommended investigations or have received recommended heart failure treatment, such as an echocardiography to detect heart failure. For those women who already had been diagnosed with the condition, they were less likely than the men to receive such drugs as ACE inhibitors and beta blockers. This is despite compelling evidence that these drugs are effective.
After they left hospital women were still much less likely to receive treatment, with the exception of diuretics, to prevent deterioration of their heart failure – this was even the case for women who had been admitted as an emergency.
In fact, only a small number of patients, both men and women, received all the appropriate recommended care after they had left hospital. Just 20% had an appointment to see a specialist who could check their progress; under 1% were referred to rehabilitation or specialist palliative care.
The researchers said treatment for coronary heart disease continues to improve, as do survival rates. As the UK population ages, heart failure will be more common.
The adoption of recommended heart failure treatment has been slower than for other heart disease areas, say the researchers. “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,” the authors conclude.
*Healthcare Commission data:
— Management of Admissions in Acute Hospitals
— Pushing the Boundaries, Improving Services for Patients with Heart Failure
“NHS heart failure survey: a survey of acute heart failure admissions in England, Wales, and Northern Ireland”
Edward D Nicol, Barbara Fittal, Michael Roughton, John G F Cleland, Henry J Dargie and Martin R Cowie
Online First Heart 2007; doi: 10.1136/hrt.2007.124107
Click here to view Abstract online
Written by׃ Christian Nordqvist