Sex differences in access to physician care following a new diagnosis of heart failure in the ambulatory setting

Background — Despite established standards for ambulatory heart failure (HF) care, gaps may persist in healthcare access and timely follow-up.

Methods — We conducted a population-based, retrospective cohort study of Ontarians aged ≥40 years who were diagnosed with HF in an ambulatory setting between April 2009 to March 2019, to evaluate the time intervals between diagnosis to subsequent physician reassessment. Primary outcome was all-cause mortality, and secondary outcome was a composite of HF hospitalization or emergency department (ED) visit for HF within one-year. The hazard of death was assessed using multivariable extended Cox models, and secondary outcomes using multivariable cause-specific hazard models with death as a competing risk.

Results — Among 188,692 patients with an incident ambulatory HF diagnosis, 178,582 were reassessed by a physician within three months of diagnosis, without significant sex differences. Approximately 1.4% had delayed and 3.9% had no physician reassessment within one year, with those receiving follow-up 3-12 months post-HF diagnosis exhibiting higher rates of one-year mortality (HR 2.58; 95%CI, 2.31-2.87) and HF hospitalizations or ED visits (HR 7.50 [6.85-8.21]). Patients with delayed reassessment often had their first physician contact in an acute setting. Additionally, sex differences were observed, with females demonstrating lower adjusted rates of one-year mortality compared to males (HR 0.92 [0.90-0.95]).

Conclusions — Patients experiencing delayed physician reassessment were at increased risk of one-year mortality and morbidity. Although most patients in this contemporary cohort had timely physician follow-up after incident outpatient HF diagnosis, gaps remain in the quality of ambulatory HF care.