Exploring Sex-Based Differences in Patient Outcomes: A Secondary Analysis of Heartwatch, an Irish Cardiovascular Secondary Prevention Program

Ivana Keenan, Fintan Stanley, Robyn Homeniuk, Michael O'callaghan, Joseph Gallagher, Claire Collins

Background:

In 2003, a secondary CVD prevention program – Heartwatch, was introduced in Ireland with the aim to reduce morbidity and mortality caused by CVDs. A recent review of overall outcomes of Heartwatch patients’ revealed sex-based differences, where female patients achieved worse secondary prevention outcomes than males. Further investigation of the differences in key risk factor outcomes is needed.

Research questions:

What are sex-based differences in risk factor outcomes in the Heartwatch program?

Method:

Anonymous data extracted from the Heartwatch database was used. Risk factors (including SBP, LDLc, Waist Circumference, Diabetes status, physical activity, and smoking) were analysed at sign-up, and at four years follow-ups. Additionally, an 8-point aggregate risk score (CCare Score) which uses key recommendation targets for males and females was assessed. Regression analysis was applied to assess the statistical significance of the differences observed.

Results:

In total 8,893 patients, of whom 78% were male were included. Females exhibited a higher risk profile across all CVD risk factors. Systolic blood pressure and waist circumferences were more likely to be off target than for males [M to F odds ratios(95% CI); Sys. BP: 1.5 (1.3-1.6), W.Circ: 1.7(1.5-1.9)], these disparities persisted even after 4 years of chronic disease management [M to F odds ratios(95% CI); Sys. BP: 1.3 (1.2-1.5), W.Circ: 1.7(1.5-1.9)]. 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)].

Conclusions:

Female patients typically started with worse CVD risk factor values across the board and did not reach the same level of improvement as male patients, even after four years of receiving the same standardised care. Further investigation into the reasons why female patients’ health measures differ from male patients is necessary to support a decrease in sex-based inequities in care and outcomes.

Points for discussion:

What are the programs used in your country for secondary CVD prevention?

Have you witnessed differences between female and male patients in your practice in terms of primary and secondary prevention of CVD?

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