Exploring sex-based differences in patient outcomes: A secondary analysis of Heartwatch, an Irish cardiovascular secondary prevention programme

Abstract

Background

In the last two decades, sex-related differences regarding cardiovascular diagnosis, treatment, and risk factors management have been reported. The current study aims to explore differences in cardiovascular outcomes among male and female patients attending the Irish secondary cardiovascular prevention programme - Heartwatch.

Methods

This is a retrospective observational study. Anonymous data was extracted from the Heartwatch database from 2003 to 2017. Cardiovascular risk factors were analysed at sign-up and at four years follow-ups. An 8-point aggregate risk score (CCare Score) was assessed to calculate targeted outcomes. Generalized estimating equations models were applied for data analysis.

Results

In total 8893 patients (77 % male) were included. Females exhibited a higher risk profile across all cardiovascular risk factors and were more likely to be off target than males at baseline and after 4 years of programme attendance [M to F odds ratios(95 % CI); systolic blood pressure: 1.35 (1.21–1.49), waist circumference: 2.11(1.89–2.36), physical activity: 1.72 (1.53–1.95)]. CCare scores also demonstrated the gap between male and female patients at baseline [mean(sd); M: 5.1(1.2), F: 4.8(1.2)] and after 4 years of structured care [mean(sd); M: 5.3(1.2), F: 4.9(1.2)]. Female patients were less likely to be prescribed aspirin and ACE inhibitors but more likely to be prescribed AT2 inhibitors, calcium channel blockers, and diuretics compared to male patients.

Conclusions

The Heartwatch programme has demonstrably improved patient care, however, the continuous underperformance of female patients necessitates further investigation to ensure appropriate and equitable secondary CVD prevention among the Irish population.