Mind the gap: sex disparities in heart failure efficiency clinic referrals
E Higgisson, T Mannion, V MaherAbstract
Introduction
Specialist heart failure (HF) services play a key role in optimisation of guideline-directed medical therapy, risk stratification, and patient education and empowerment. Sex-based differences in referral to specialist HF services remain incompletely characterised. We aimed to describe sex differences in clinical characteristics, symptom burden, healthcare utilisation, and pragmatic risk stratification in a cohort of consecutive referrals to a specialist HF service.
Methods
We performed a retrospective observational analysis of 100 consecutive patients referred to a tertiary HF service. Consecutive referrals were included to reflect real-world referral patterns. Demographics, comorbidities, left ventricular ejection fraction (LVEF), biomarkers, New York Heart Association (NYHA) class, recent hospitalisation, medication use, and aetiology were recorded. QUAD scores were calculated for patients with reduced or mildly reduced ejection fraction. Analyses were intentionally descriptive and exploratory, given the sample size and sex imbalance.
Results
Of the 100 consecutive referrals, 72 were men (72%) and 28 were women (28%). Baseline demographic characteristics are summarised in Figure 1. Mean LVEF was similar between women and men (35.1% vs 35.5%), as were comorbidity burden and QUAD score distributions. Women demonstrated trends toward higher NYHA class and greater recent hospitalisation as demonstrated in Figure 2. Women had higher NT-proBNP levels, despite comparable objective cardiac function. The distribution of HF phenotypes and underlying aetiology differed between sexes, with a higher proportion of HFpEF among women. Use of guideline-directed medical therapy was broadly similar, although women were more frequently prescribed loop diuretics (71% vs 56%), consistent with greater symptomatic congestion.
Conclusions
In this real-world cohort of consecutive referrals, women were under-represented and exhibited greater symptom burden and healthcare utilisation despite similar cardiac function and pragmatic risk stratification. These findings provide contemporary insight into sex-based differences at the point of specialist assessment. This study is hypothesis-generating and supports further prospective evaluation of sex-based differences at the point of specialist HF referral.Figure 1:Baseline CharacteristicsFor image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.