Patient, physician gender influences HF treatment

22 January 2009

MedWire News: Treatment for chronic heart failure (CHF) is influenced by both the patient’s and physician’s gender, according to a study appearing in the European Heart Journal.

The findings indicate that women with CHF are less likely to receive evidence-based treatment than men, in particular being less likely to be prescribed ACE inhibitors and receiving lower doses of beta blockers.

They also demonstrate for the first time that patients receive more comprehensive treatment from female than male physicians overall.

Indeed, female physicians did not treat men and women with CHF differently with regard to use and dosages of evidence-based drugs. And women received the worst treatment from a male physician whereas men were best treated by a female physician.

Lead author Magnus Baumhäkel commented: “The use of evidence-based treatments as described in the latest guidelines has undoubtedly improved the treatment of CHF. But there is still evidence of a gender imbalance in both patients and physicians. From our results it seems fair to say that the gender of the physician plays an important role in adherence to drug treatment recommendations in CHF.”

Baumhäkel, from University Hospital of the Saarland in Homburg/Saar, Germany, and colleagues studied 1857 consecutive patients with CHF who were evaluated in centers in eastern Germany between March and November 2006. Data on their co-morbidities, New York Heart Association classification, current treatment, and vital parameters at baseline, the evidence-based treatments they were then prescribed, and the gender, age, and some professional details of the treating physician were documented.

The use of ACE inhibitors and angiotensin receptor blockers (ARBs) was significantly higher in male than female patients (p=0.021) and recommended doses tended to be higher in male patients (p=0.058), the team reports.

Meanwhile, male patients tended to receive beta blockers more often (p=0.075) and received them at significantly higher doses (p=0.021) than their female counterparts.

Of note, the use of ACE inhibitors or ARBs and beta blockers was significantly lower in female patients treated by a male physician than in males treated by either a male or female physician. And the dose received was highest among male patients treated by a female physician, being significantly higher than that received by female patients treated by a male physician.

Beta blocker use was highest in male patients treated by a female physician compared with other possible combinations. Whereas the dose received was comparable in men treated by physicians of either gender, female patients treated by a male physician received the lowest doses of all possible combinations.

Physician’s gender and the interaction of physician’s with patients’ gender proved to be independent predictors for receipt of a beta blocker in multivariable analysis.

Baumhäkel and co-authors conclude: “Physicians should be aware of this problem in order to avoid bias in the treatment of these patients. Further studies are required to provide a detailed explanation of this phenomenon.”

Eur Heart J 2009; Advance online publication