Table 1
Baseline characteristics of HF QUIK participants in control and intervention periods by sex.
| Participant characteristics | Control | P-value | Intervention | P-value | ||
|---|---|---|---|---|---|---|
| Male N = 441 n (%) | Female N = 317 n (%) | Male N = 423 n (%) | Female N = 219 n (%) | |||
| Age, mean (SD), y | 65.3 (12.1) | 68.7 (12.5) | <0.001 | 65.0 (11.5) | 69.6 (12.2) | <0.001 |
| Transferred from another facility | 168 (38.1) | 114 (36.0) | 0.800 | 150 (35.5) | 75 (34.2) | 0.560 |
| Ischemic etiology of HF | 386 (87.5) | 248 (78.2) | 0.002 | 387 (91.5) | 183 (83.6) | 0.011 |
| Self-reported medical history prior to HF admission | ||||||
| Tobacco use | 260 (59.0) | 7 (2.2) | <0.001 | 231 (54.6) | 2 (0.9) | <0.001 |
| Alcohol use | 183 (41.5) | 4 (1.3) | <0.001 | 153 (36.2) | 1 (0.5) | <0.001 |
| Coronary heart disease | 269 (61.0) | 140 (44.2) | <0.001 | 257 (60.8) | 120 (54.8) | 0.150 |
| Percutaneous coronary intervention | 50 (11.3) | 17 (5.4) | 0.004 | 51 (12.1) | 11 (5.0) | 0.004 |
| Diabetes mellitus | 234 (53.1) | 194 (61.2) | 0.026 | 206 (48.7) | 133 (60.7) | 0.004 |
| Hypertension | 241 (54.6) | 206 (65.0) | 0.004 | 239 (56.5) | 132 (60.3) | 0.360 |
| Hyperlipidemia | 80 (18.1) | 81 (25.6) | 0.014 | 92 (21.7) | 42 (19.2) | 0.450 |
| Valvular heart disease | 28 (6.3) | 24 (7.6) | 0.510 | 17 (4.0) | 19 (8.7) | 0.015 |
| Rheumatic heart disease | 11 (2.5) | 13 (4.1) | 0.210 | 6 (1.4) | 15 (6.8) | <0.001 |
| Chronic kidney disease | 92 (20.9) | 37 (11.7) | <0.001 | 77 (18.2) | 20 (9.1) | 0.002 |
| Stroke | 31 (7.0) | 23 (7.3) | 0.910 | 33 (7.8) | 9 (4.1) | 0.073 |
| Implantable cardioverter defibrillator | 5 (1.1) | 0 (0.0) | 0.057 | 4 (0.9) | 0 (0.0) | 0.150 |
| Cardiac resynchronization therapy | 3 (0.7) | 2 (0.6) | 0.930 | 3 (0.7) | 1 (0.5) | 0.700 |
| Medications prior to HF admission | ||||||
| Loop diuretic | 181 (41.0) | 116 (36.6) | 0.220 | 161 (38.1) | 97 (44.3) | 0.130 |
| Thiazide diuretic | 7 (1.6) | 1 (0.3) | 0.091 | 3 (0.7) | 5 (2.3) | 0.088 |
| ACE-I or ARB | 99 (22.5) | 80(25.2) | 0.373 | 92 (21.8) | 64 (29.2) | 0.036 |
| Beta-blocker | 142 (32.2) | 91 (28.7) | 0.300 | 163 (38.5) | 84 (38.4) | 0.960 |
| Aldosterone antagonist | 88 (20.0) | 47 (14.8) | 0.069 | 58 (13.7) | 29 (13.2) | 0.870 |
| ARNi | 7 (1.6) | 3 (0.9) | 0.450 | 3 (0.7) | 0 (0.0) | 0.210 |
| Digoxin | 49 (11.1) | 29 (9.1) | 0.380 | 27 (6.4) | 25 (11.4) | 0.027 |
| Ivabradine | 17 (3.9) | 17 (5.4) | 0.320 | 15 (3.5) | 5 (2.3) | 0.380 |
| Aspirin | 210 (47.6) | 124 (39.1) | 0.020 | 208 (49.2) | 110 (50.2) | 0.800 |
| Statin | 211 (47.8) | 136 (42.9) | 0.180 | 214 (50.6) | 116 (53.0) | 0.570 |
| Physical exam, laboratory and imaging | ||||||
| Weight, mean (SD), kg | 65.8 (11.7) | 60.3 (10.2) | <0.001 | 66.4 (10.1) | 60.2 (10.4) | <0.001 |
| Systolic blood pressure, mean (SD), mmHg | 137.6 (29.9) | 140.2 (30.5) | 0.240 | 141.2 (31.1) | 141.7 (29.5) | 0.850 |
| Diastolic blood pressure, mean (SD), mmHg | 82.9 (16.4) | 81.7 (14.1) | 0.320 | 83.7 (16.3) | 83.2 (13.8) | 0.740 |
| Heart rate, mean (SD), bpm | 91.4 (23.0) | 96.4 (23.4) | 0.003 | 94.3 (23.2) | 93.7 (24.9) | 0.750 |
| Sodium, mean (SD), mEq/L | 135.0 (5.9) | 134.1 (6.7) | 0.067 | 134.9 (5.2) | 134.4 (4.9) | 0.230 |
| Creatinine, median (IQR), mg/dL | 1.3 (1.0, 1.8) | 1.1 (0.9, 1.5) | <0.001 | 1.3 (1.0, 1.8) | 1.1 (0.9, 1.6) | <0.001 |
| Ejection fraction, mean (SD), % | 34.5 (9.3) | 37.1 (10.5) | <0.001 | 33.9 (9.1) | 36.6 (10.2) | <0.001 |
[i] ACE-I: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, ARNi: angiotensin receptor neprilysin inhibitor, IQR: interquartile range.
Table 2
In-hospital tests, procedures, and treatment of HF QUIK participants in control and intervention periods by sex.
| Diagnostic tests and treatment | Control | P-value | Intervention | P-value | ||
|---|---|---|---|---|---|---|
| Male N = 441 n (%) | Female N = 317 n (%) | Male N = 423 n (%) | Female N = 219 n (%) | |||
| In-hospital tests and procedures | ||||||
| ECG, No. (%) | 436 (98.9) | 315 (99.4) | 0.48 | 423 (100.0) | 218 (99.5) | 0.16 |
| Cardioversion, No. (%) | 16 (3.6) | 7 (2.2) | 0.26 | 11 (2.6) | 3 (1.4) | 0.31 |
| Stress testing, No. (%) | 0 (0.0) | 1 (0.3) | 0.24 | 0 | 0 | |
| Coronary angiography, No. (%) | 115 (26.1) | 48 (15.1) | <0.001 | 108 (25.5) | 25 (11.4) | <0.001 |
| Percutaneous coronary intervention, No. (%) | 34 (7.7) | 11 (3.5) | 0.015 | 39 (9.2) | 5 (2.3) | <0.001 |
| Coronary artery bypass graft, No. (%) | 3 (0.7) | 3 (0.9) | 0.68 | 7 (1.7) | 2 (0.9) | 0.45 |
| Implantable cardioverter defibrillator, No. (%) | 3 (0.7) | 1 (0.3) | 0.49 | 3 (0.7) | 0 (0.0) | 0.21 |
| Cardiac resynchronization therapy, No. (%) | 1 (0.2) | 0 (0.0) | 0.40 | 2 (0.5) | 1 (0.5) | 0.98 |
| Intra-aortic balloon pump, No. (%) | 0 | 0 | 1 (0.2) | 0 (0.0) | 0.47 | |
| Dialysis or ultrafiltration, No. (%) | 4 (0.9) | 4 (1.3) | 0.64 | 8 (1.9) | 1 (0.5) | 0.14 |
| Non-invasive positive pressure ventilation, No. (%) | 110 (24.9) | 108 (34.1) | 0.006 | 112 (26.5) | 112 (26.5) | 0.71 |
| Mechanical ventilation, No. (%) | 39 (8.8) | 29 (9.1) | 0.88 | 39 (9.2) | 18 (8.2) | 0.67 |
| In-hospital treatment | ||||||
| Loop diuretic, No. (%) | 411 (93.2) | 302 (95.3) | 0.23 | 415 (98.1) | 216 (98.6) | 0.63 |
| Thiazide diuretic, No. (%) | 8 (1.8) | 8 (2.5) | 0.50 | 10 (2.4) | 6 (2.7) | 0.77 |
| ACE-I or ARB, No. (%) | 170 (38.6) | 140 (44.2) | 0.121 | 173 (40.9) | 110 (50.2) | 0.024 |
| Beta-blocker, No. (%) | 317 (71.9) | 225 (71.0) | 0.79 | 317 (74.9) | 161 (73.5) | 0.69 |
| Aldosterone antagonist, No. (%) | 259 (58.7) | 177 (55.8) | 0.43 | 278 (65.7) | 153 (69.9) | 0.29 |
| ARNi, No. (%) | 11 (2.5) | 6 (1.9) | 0.58 | 8 (1.9) | 0 (0.0) | 0.041 |
| Digoxin No. (%) | 90 (20.4) | 63 (19.9) | 0.86 | 62 (14.7) | 45 (20.5) | 0.058 |
| Ivabradine, No. (%) | 42 (9.5) | 36 (11.4) | 0.41 | 49 (11.6) | 21 (9.6) | 0.44 |
| Aspirin, No. (%) | 376 (85.3) | 256 (80.8) | 0.10 | 377 (89.1) | 179 (81.7) | 0.009 |
| Statin, No. (%) | 374 (84.8) | 264 (83.3) | 0.57 | 379 (89.6) | 180 (82.2) | 0.008 |
| Hydralazine-nitrate, No. (%) | 28 (6.3) | 17 (5.4) | 0.57 | 16 (3.8) | 7 (3.2) | 0.70 |
| Nitroglycerin, No. (%) | 129 (29.3) | 90 (28.4) | 0.80 | 137 (32.4) | 67 (30.6) | 0.64 |
| Inotrope, No. (%) | 81 (18.4) | 48 (15.1) | 0.24 | 92 (21.7) | 34 (15.5) | 0.06 |
[i] ECG: electrocardiogram, ACE-I: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, ARNi: angiotensin receptor neprilysin inhibitor.
Table 3
Process of care measures and clinical outcomes of HF QUIK participants in control and intervention periods by sex.
| Control | P-value | Intervention | P-value | |||
|---|---|---|---|---|---|---|
| Male n (%) | Female n (%) | Male n (%) | Female n (%) | |||
| Discharge process of care measures1 | ||||||
| GDMT at discharge2 | 73 (26.4) | 51 (30.9) | 0.29 | 110 (39.7) | 57 (44.9) | 0.33 |
| ACE-I or ARB at discharge2 | 118 (42.6) | 82 (49.7) | 0.14 | 132 (47.7) | 75 (59.1) | 0.036 |
| Beta-blocker at discharge2 | 209 (75.5) | 124 (75.2) | 0.98 | 231 (83.4) | 101 (79.5) | 0.35 |
| Aldosterone antagonist at discharge2 | 177 (63.9) | 109 (66.1) | 0.62 | 208 (75.1) | 97 (76.4) | 0.78 |
| Diuretic at discharge2 | 258 (93.1) | 153 (92.7) | 0.94 | 271 (97.8) | 126 (99.2) | 0.32 |
| Tobacco cessation counseling3 | 253 (77.6) | 13 (13.8) | <0.001 | 225 (76.8) | 4 (6.5) | <0.001 |
| Alcohol cessation counseling3 | 232 (74.1) | 14 (14.9) | <0.001 | 209 (74.6) | 4 (6.3) | <0.001 |
| Diet counseling | 347 (85.5) | 242 (84.6) | 0.13 | 339 (88.5) | 171 (83.8) | 0.11 |
| Weight monitoring instructions | 340 (83.7) | 236 (82.5) | 0.047 | 339 (88.5) | 168 (82.4) | 0.075 |
| Referral to outpatient cardiac rehabilitation | 16 (3.9) | 14 (4.9) | 0.54 | 12 (3.1) | 4 (2.0) | 0.40 |
| Referral for ICD therapy4 | 16 (7.1) | 4 (3.1) | 0.12 | 4 (1.9) | 4 (4.3) | 0.22 |
| Outpatient clinic follow-up scheduled | 361 (88.9) | 257 (89.9) | 0.66 | 367 (95.8) | 198 (97.1) | 0.45 |
| In-hospital process of care measures | ||||||
| ECG | 436 (98.9) | 315 (99.4) | 0.48 | 423 (100.0) | 218 (99.5) | 0.16 |
| Transthoracic echocardiogram | 418 (95.0) | 292 (92.1) | 0.10 | 390 (92.2) | 201 (91.8) | 0.85 |
| Clinical outcomes | ||||||
| Hospital length of stay, median (IQR), days | 4.0 (3.0, 6.0) | 4.0 (3.0, 7.0) | 0.57 | 4.0 (3.0, 6.0) | 4.0 (3.0, 6.0) | 0.51 |
| Inpatient mortality | 35 (8.0) | 31 (9.8) | 0.37 | 40 (9.5) | 15 (6.8) | 0.26 |
[i] 1 Among participants discharged; N = 1279 with 692 in control period (406 male, 286 female) and 587 in intervention period (383 male, 204 female).
2 Among participants discharged with LVEF <40%; N = 846 with 442 in control period (277 male, 165 female) and 404 in intervention period (277 male, 127 female).
3 Among participants who responded to using tobacco or alcohol; for tobacco use (N = 775, control period (N = 420; 326 male, 94 female); intervention period (N = 355, 293 male, 62 female) and alcohol use (N = 750, control period (N = 407, 313 male; 94 female); intervention period (N = 343, 280 male; 63 female).
4 Among participants with LVEF ≤35%; N = 688 with 366 in control period (231 male, 135 female) and 322 in intervention period (222 male, 100 female).
ACE-I: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, GDMT: guideline-directed medical therapy, ICD: implantable cardioverter defibrillator, LVEF: left ventricular ejection fraction, ECG: electrocardiogram.
Figure 1
Sex-specific differences in the intervention effect for process of care measures and clinical outcomes. GDMT: guideline-directed medical therapy, ACE-I: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, ICD: implantable cardioverter defibrillator, ECG: electrocardiogram.