Physiologic variables, medical therapy, and psychosocial issues: Effect of gender and outcome

Gender-based differences in biopsychosocial variables and outcomes have been identified in patients with coronary artery disease, however, it is unknown if differences occur in patients with congestive heart failure (CHF). The purpose of this study was to describe gender-based differences and outcomes in patients with CHF related to: (1) selected physiologic variables; (2) medical therapy; (3) selected psychosocial issues; (4) resource utilization; and (5) short-term mortality. A secondary purpose was to identify gender-based changes in psychosocial variables over time and to examine the relationship between specific physiological and psychosocial variables and resource utilization/mortality. Over a 6-month period, ninety patients (46 men and 44 women) with CHF were recruited following admission to a tertiary care center in southwestern PA. Baseline physiologic data, medications prescribed, and length of stay information were obtained at baseline (admission). Subjects completed the: (1) Minnesota Living with Heart Failure Questionnaire (LHFQ) to measure health related quality of life (HRQoL); (2) Duke Activity Status Index (DASI) measuring functional status (FS); (3) Interpersonal Support Evaluation List (ISEL) measuring social support (SS); and (4) Center for Epidemiologic Studies Depression Scale (CESD-I) measuring depression at baseline and 3- and 6-months post-discharge. Resource utilization and mortality were also examined. Data were analyzed using descriptive statistics, t-tests, Chi-square, non-parametric equivalents, ANOVA/MANOVA, and correlation analysis including Fishers r-to-z conversion and logistic regression.;At baseline, left ventricular ejection fraction (LVEF) was significantly higher (p = 0.0004) in women. However, there were no gender differences in the other physiologic (NYHA classification and atrial fibrillation) or psychosocial variables (FS, HRQoL, SS, and depression). Medications used for CHF were prescribed similarly in men and women, other than digoxin, which was used more in men (p = 0.001). Most patients reported depressive symptoms at baseline (63.3%). Moderate to strong correlations were found between HRQoL and SS (p ≤ 0.01), between HRQoL and FS (p ≤ 0.01), and between depression and SS (p ≤ 0.01). FS, HRQoL, and depression scores improved over time. During the 6-month study period, 68.3% of men and 53.7% of women were readmitted at least once (p = NS), and 13.3% died. Functional status (p = .01) and atrial fibrillation (p = .04) were found to be predictors of readmission/mortality.