Gender differences in efficiency of the telemedicine care of heart failure patients. The results from the TeleEduCare-HF study.

Abstract

Introduction: The aim of this study was to implement a model of healthcare for patients with heart failure (HF) and to assess the differences between men and women in the study population.

Material and methods: Through care and an extensive educational panel (dietary recommendations, physical activity, titration of diuretics, psychological support), emphasis was placed on prevention. All patients had a baseline cardiology consultation with recommendations regarding treatment, self-care, diet, and exercise. Based on regular measurements of weight and blood pressure HF patients were telemonitored by nurses, primary care physicians and referred to cardiologists when necessary. The questionnaire was conducted in all patients at baseline after enrollment to the study and after 3 months of telemonitoring and extensive educational process.

Results: The study finally included 140 men with an average age of 66 years (SD: 56-71) and 163 women with an average age of 64 years (58-72). The ischemic origin of HF was present in 78% of men and 73% of women (p = 0.40), and 31% of men and 16% of women declared myocardial infarction in the past (p = 0.002). Men more often survived sudden cardiac arrest (7.8% vs. 1.2%; p = 0.004) and had implantable cardiac devices compared to women (16% vs. 3%; p = 0.001). Male patients reported significantly more often alcohol consumption, smoking, and less frequently any physical activity. Women significantly more often than men suffered from cancer, depression, and thromboembolic events and less frequently from obstructive sleep apnea. The mean left ventricular ejection fraction (LVEF) was 43% (SD: 30-58) for men, and 57% (45-63) for women (p = 0.0001), and women suffered mainly from heart failure with preserved ejection fraction. There were no differences between genders regarding the number of hospitalizations in last 12 months. The men, despite lower LVEF, felt short of breath/tired when climbing the stairs up than women (3 [2-4] vs. 2 floors [1-3]; p = 0.001), had higher distance in meters when walking on flat ground (400 [200-400] vs. 300 m [100-400]; p = 0.0001), and less frequently had to get up to go to the toilet at night (p = 0.03). Men also suffered significantly less often from shortness of breath at rest, swelling of the lower limbs and shortness of breath that wakes them up at night. Only 35% of men and 19% of women had HF self-care training, and only 35% of men and 46% of women knew how to increase the dose of diuretic on their own if shortness of breath or swelling increases. Based on the EuroQol-5 dimensions 5-levels questionnaire, significantly more women than men reported moderate and serious problems with moving around, serious problems with performing ordinary activities independently as well as moderate and serious pain problem and a significant level of anxiety. Men more often than women reported serious problems with self-care.

Conclusions: Women suffer more often from HF symptoms and have worse quality of life assessed in EQ-5D-5L than men despite their higher LVEF.