P173 - SEX SPECIFIC COMPARISON OF ACUTE HEART FAILURE PRESENTATION IN THE EMERGENCY DEPARTMENT: BASELINE CHARACTERISTICS OF THE SEX SUBSTUDY OF THE COACH TRIAL

Background: Heart failure (HF) affects  64 million people worldwide. Care of patients with HF accounts for a significant proportion of healthcare system expenditures, with hospitalizations accounting for the majority of costs. While male and female patients have similar lifetime risk of HF, females are more likely to have a higher burden of symptoms, worse quality of life, and higher risk of readmission.

The Comparison of Outcomes and Access to Care for Heart failure (COACH) trial demonstrated that a multipronged strategy of risk stratification in the emergency department (ED) and rapid post-discharge follow-up clinic care of low-risk patients improved outcomes at 30-days and longer-term follow-up. Previous literature has suggested that females are more likely to experience HF readmission within one year of follow-up, while males were more likely to be readmitted when follow-up extended over longer time horizons. Median follow-up was 280 days in the COACH trial, but it is unknown if beneficial effects of the intervention extend to both sexes.

METHODS AND RESULTS: COACH was a stepped-wedge, cluster-randomized trial that tested use of (1) an acute HF risk stratification algorithm (EHMRG30-ST), (2) recommendations for high risk patients to be admitted and for low risk patients to be discharged early, and (3) referral for rapid outpatient follow-up from the ED or if early discharge from hospital occurred (length of stay < 3 days). Patients with clinical HF, ≥ 18 years of age, presenting to the ED were included. Primary outcome was a composite outcome of 30-day all-cause mortality or cardiovascular hospitalization. We conducted a pre-specified subgroup analysis by testing whether sex modified the intervention effect and estimating sex-specific treatment effect estimates.

Results at baseline showed that among a total cohort of 5452 patients, 2461 were female, 2991 were male. Patient characteristics are shown in Table 1. Females were older and more likely to arrive to the emergency department by ambulance. Males had more myocardial infarction; troponin was elevated in a higher proportion of males. Other comorbidities were similar. There were similar rates of medication use in female and male patients. More females had preserved ejection fraction while more males had reduced ejection fraction.

Conclusion: Preliminary results indicate baseline differences in the demographics and presentation of female and male patients presenting with HF to the ED. While baseline sex differences exist, we hypothesize that the benefits of the COACH intervention will extend to both males and females in a planned subgroup analysis.