Age- and gender-related differences in quality of care and outcomes of patients hospitalized with heart failure (from OPTIMIZE-HF)

Abstract

Previous studies have suggested that female and elderly patients with heart failure (HF) are less likely to receive guideline-recommended therapies, but these studies have involved select patient populations. We evaluated the differences in medical care and patient outcomes by age and gender among a broad cohort of hospitalized patients with HF. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) is a registry and performance-improvement program involving 48,612 patients with HF from 259 hospitals. The data were analyzed by gender, age <75 years, and age > or =75 years. Appropriate angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker use were similar between women and men (p = 0.244 and p = 0.237, respectively). However, compared with men, fewer women received hospital discharge instructions (p <0.001) and the length of stay was longer (p <0.001). Risk-adjusted in-hospital and postdischarge mortality were similar. All guideline-recommended cardiac medications were prescribed less frequently at discharge to eligible patients > or =75 than to those <75 years (all p <0.001). Older age was independently associated with in-hospital and postdischarge mortality risk increases (76% and 62%, respectively; p <0.001 for both). In conclusion, among the OPTIMIZE-HF hospitals, female patients with HF generally received similar medical care and had similar risks of adverse clinical outcomes compared with male patients. Older patients with HF were less likely to receive guideline-recommended therapies and remained at greater risk of adverse outcomes.

Trial registration: ClinicalTrials.gov NCT00344513.