Open AccessPresentation, Management, and In-Hospital Outcomes of Patients with Acute Heart Failure in South India by Sex: A Secondary Analysis of a Prospective, Interrupted Time Series Study
Author(s) -
Anubha Agarwal,
P.P. Mohanan,
Dimple Kondal,
Aashima Chopra,
Abigail S. Baldridge,
Divin Davies,
Raji Devarajan,
Govindan Unni,
Jabir Abdullakutty,
Syam Natesan,
Johny Joseph,
P.B. Jayagopal,
Stigi Joseph,
Rajesh Gopalakrishna,
Dorairaj Prabhakaran,
Mark D. Huffman
Publication year - 2021
Publication title -
global heart
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 37
eISSN - 2211-8179
pISSN - 2211-8160
DOI - 10.5334/gh.1043
Subject(s) - medicine , heart failure , ejection fraction , percutaneous coronary intervention , guideline , logistic regression , prospective cohort study , odds ratio , clinical endpoint , presentation (obstetrics) , emergency medicine , myocardial infarction , pediatrics , surgery , randomized controlled trial , pathology
Background: Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India. Objective: We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study. Methods: The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models. Results: Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, p interaction = 0.69). Conclusions: We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.