Sex-Specific Clinical Outcomes of the PACT-HF Randomized Trial.

Abstract

BACKGROUND:

Transitional care may have different effects in males and females hospitalized for heart failure. We assessed the sex-specific effects of a transitional care model on clinical outcomes following hospitalization for heart failure.

METHODS:

In this stepped-wedge cluster randomized trial of adults hospitalized for heart failure in Ontario, Canada, 10 hospitals were randomized to a group of transitional care services or usual care. Outcomes in this exploratory analysis were composite all-cause readmission, emergency department visit, or death at 6 months; and composite all-cause readmission or emergency department visit at 6 months. Models were adjusted for stepped-wedge design and patient age.

RESULTS:

Among 2494 adults, mean (SD) age was 77.7 (12.1) years, and 1258 (50.4%) were female. The first composite outcome occurred in 371 (66.3%) versus 433 (64.1%) males (hazard ratio [HR], 1.04 [95% CI, 0.86-1.26]; P=0.67) and in 326 (59.9%) versus 463 (64.8%) females (HR, 0.83 [95% CI, 0.69-1.01]; P=0.06) in the intervention and usual care groups, respectively (P=0.012 for sex interaction). The second composite outcome occurred in 357 (63.8%) versus 417 (61.7%) males (HR, 1.03 [95% CI, 0.85-1.24]; P=0.76) and 314 (57.7%) versus 450 (63.0%) females (HR, 0.81 [95% CI, 0.67-0.99]; P=0.037) in the intervention and usual care groups, respectively (P=0.024 for sex interaction). The sex differences were driven by a reduction in all-cause emergency department visits among females (HR, 0.66 [95% CI, 0.51-0.87]; P=0.003), but not males (HR, 1.10 [95% CI, 0.85-1.43]; P=0.46), receiving the intervention (P<0.001 for sex interaction).

CONCLUSIONS:

A transitional care model offered a reduction in all-cause emergency department visits among females but not males following hospitalization for heart failure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02112227.

• Authors: Harriette G C Van Spall, Ersilia M DeFilippis, Shun Fu Lee, Urun Erbas Oz, Richard Perez, Jeff S Healey, Larry A Allen, Adriaan A Voors, Dennis T Ko, Lehana Thabane, Stuart J Connolly
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 14 Issue 11 Pg. e008548 (11 2021) ISSN: 1941-3297 [Electronic] United States
• PMID: 34711072 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Emergency Service, Hospital (statistics & numerical data)
• Female
• Heart Failure (therapy)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Quality of Life
• Randomized Controlled Trials as Topic
• Sex Factors
• Transitional Care (statistics & numerical data)