Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study

Eur J Heart Fail. 2009 Mar;11(3):299-303. doi: 10.1093/eurjhf/hfn041. Epub 2009 Jan 21.


Aims: Clinical outcomes of patients with chronic heart failure (CHF) have improved, but evidence-based treatment appears to be imbalanced depending on patients' and physicians' gender. We aimed to determine the interactions of gender with medical treatment of CHF.

Methods and results: Consecutive patients with CHF (n = 1857) were evaluated regarding co-morbidities, New York Heart Association classification, current medical treatment, and dosage of angiotensin-converting enzyme-inhibitors (ACE-Is) and beta-blockers. Gender of patients and treating physicians was recorded. Baseline characteristics of patients and physicians were comparable for males and females. Female patients were less frequently treated with ACE-Is, angiotensin-receptor blockers, or beta-blockers. Achieved doses were lower in female compared with male patients. Guideline-recommended drug use and achieved target doses tended to be higher in patients treated by female physicians. There was no different treatment for male or female patients by female physicians, whereas male physicians used significantly less medication and lower doses in female patients. In multivariable analysis, female gender of physicians was an independent predictor of use of beta-blockers.

Conclusion: Treatment of CHF is influenced by patients', but also physicians' gender with regard to evidenced-based drugs and their dosage. Physicians should be aware of this problem in order to avoid gender-related treatment imbalances.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Cross-Sectional Studies
  • Evidence-Based Medicine / methods
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Guideline Adherence*
  • Heart Failure / drug therapy
  • Heart Failure / epidemiology*
  • Humans
  • Male
  • Patient Compliance
  • Physicians / statistics & numerical data*
  • Practice Guidelines as Topic / standards*
  • Retrospective Studies
  • Sex Factors
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors