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Design and Participants: This study retrospectively examined gender differences among patients hospitalized with HF who received an initial PC consultation in the Mount Sinai Health System. Patient information, diagnostic codes, and the PC consult assessment (including Karnofsky Performance Status [KPS] and Edmonton Symptom Assessment Scale [ESAS]) were extracted from electronic health records. The population was stratified by self-identified gender, and generalized linear models were used.
Results: Patients (N=667) were 49% women; were aged a mean of 74 (±16) years; and were 30% White, 30% Black, 25% Hispanic, 4% Asian, and 12% other. Women were older than men (77±17 yrs vs 71±15 yrs, P<.001) and less likely to be married (19% vs 46%, P<.001). Women had worse functional status (KPS=35%±16 vs 40%±17, P<.002), were less likely to have capacity to designate a surrogate medical decision-maker (62% vs.71%, P=.03), had higher symptom burden (ESAS=21±11 vs 18±11, P=.004), and were likelier to experience severe symptoms (42% vs 29%, P<.001) upon initial PC consultation. Among patients less than median age, women had lower functional status (KPS=36%±18 vs 41%±19, P=.01) and higher symptom burden (ESAS=22±11 vs 17±11, P=.001). Black women had worse functional status and higher symptom burden vs Black men (KPS=35%±15 vs 43%±17, P=.004; ESAS=20±10 vs 15±10, P=.002). Similarly, Hispanic women had worse functional status and symptom burden vs Hispanic men (KPS=35%±18 vs 43%±17, P=.038; ESAS=21±10 vs 16±9.9, P=.002). The association of gender with functional status and symptom burden remained after adjusting for possible confounders.
Commentary: Several decades of research have documented gender inequities in the diagnosis and treatment of cardiovascular issues. This current study suggests that as cardiovascular disease advances, women may also have increased suffering and more unmet needs. Importantly, these disparities were exacerbated for younger women of color, highlighting the concept of intersectionality: experiences of oppression may be compounded when individuals have multiple minoritized identities. This difference in the lived experience of women with heart failure highlights the need for differential efforts to connect women with resources earlier in the disease course to address experiential inequity. An embedded palliative care practitioner in heart failure clinic, for example, allowed for early referral to palliative care of both men and women and erased gender differences in symptom and need burden.
Bottom Line: Targeted interventions to connect women with heart failure to palliative care resources earlier in their disease course may be warranted.
Reviewer: Lawson Marcewicz, MD, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta GA
References:
- Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006.
- Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet Lond Engl. 2020;396(10250):565-582. doi:10.1016/S0140-6736(20)31561-0.
- Regitz-Zagrosek V. Therapeutic implications of the gender-specific aspects of cardiovascular disease. Nat Rev Drug Discov. 2006;5(5):425-438. doi:10.1038/nrd2032.
Source: Blum M, Frydman JL, Zeng L, et al. Gender differences regarding palliative care consultation among persons hospitalized with heart failure. J Pain Symptom Manage. 2024;68(5):477-487.e4. doi:10.1016/j.jpainsymman.2024.07.033.
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