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Gender, side effects, and prescription rates

In 2000 Harjai, et al. showed that, of patients who received in hospital care by cardiologists, men were more likely to receive combination therapy. However, of patients who saw non-cardiac specialists, women were more likely to receive Digoxin and combination therapy. [16]

As with ACE-inhibitor efficacy, prescription rates also show conflicting results:

  • Some studies show that women are prescribed ACE-inhibitors less often than men [17][18][19]

  • One study showed that women suffer from more adverse effects when treated with ACE-inhibitors than men [23]

 

 

It is important to note that overall, ACE-Inhibitors are under prescribed to both genders [24]

  • One major study showed that 32% of patients were discharged from hospital without an ACE inhibitor prescription [25]

    • These patients have a 14% greater risk of dying within a year than those who have been properly treated with the drug.

  • Young men are more commonly treated with diuretics than young women. [26][27]

  • Elderly women are more commonly treated with diuretics than elderly men [26][27]

Medications

 

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11. CONSENSUS trial study group.Effect of enalapril on mortality in severe congestive heart failure.N Engl J Med 1987;316:1429 –35.

16. Harjai KJ, Nunez E, Humphrey S, Turgut T, Shah M, Newman J. Does gender bia exist in the medical management of heart failure? International Journal of Cardiology. 2000;75:65-69.

17. Clinical Quality Improvement Network Investigators.Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure.. Arch Intern Med 1996;156:1669 –73.

18. Opasich C, Tavazzi L, Lucci D, Gorini M, Albanese M, Cacciatore G, Maggioni A.Comparison of one-year outcome in women versus men with chronic congestive heart failure. Am J Cardiol 2000;86:353 –7.

19. Agvall B, Dahlstro¨m U.Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences.Scand J Prim Health Care win pressx.

20. Philbin EF, DiSalvo TG.Influence of race and gender on care process, resource use and outcomes in congestive heart failure. Am J Cardiol 1998;82:76 –81.

21. Clarke KW, Gray D, Hampton JR.Evidence of inadequate investigation and treatment of patients with heart failure.Br Heart J 1994;71:584 –7.

22. Ayanian JZ, Weissman JS, Chasan-Taber S, Epstein AM. Quality of care by race and gender for congestive heart failure and pneumonia.Med Care 1999;37:1260 –9.

23. The SOLVD Investigators.Adverse effects of enalapril in the studies of left ventricular dysfunction.Am Heart J 1996;131:350 –5.

24. Galvao M, Kalman J, DeMarco T, Fonarow GC, Galvin C, Ghali JK, Moskowitz RM, on behalf of the ADHERE scientific advisory committee, investigators, coordinators, and study group. Gender Differences in In-Hospital Management and Outcomes in Patients With Decompensated Heart Failure: Analysis From the Acute Decompensated Heart Failure National Registry (ADHERE). Journal of Cardiac Failure. 2006;12(2):100-107.

25. Masoudi FA, Rathore SS, Wang Y, Havranek EP, Curtis JP, Foody JM, et al. National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation. 2004;110(6):724–731.

26. Adams KF, Dunlap SH, Sueta CA, Clarke SW, Patterson JH, Blauwet M, Jensen LR, Tomasko L.Relation between gender, etiology and survival in patients with symptomatic heart failure. J Am Coll Cardiol 1996;28:1781 –8.

27. Agvall B, Dahlstro¨m U.Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences.Scand J Prim Health Care win pressx.

All references for this section