Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study: reply
We thank Drs Duvernoy and Meier for their comments on our study.1 Evaluation of the influence of physicians' gender on quality of medical treatment is difficult to perform. You are right with the suggestion that controlled trials cannot be applied to this question. Thus, we chose an observational survey with all of its disadvantages. However, we tried to consider the possible confounders in the multivariate analysis. Nevertheless, we think that there might be an influence of physicians' gender on medical treatment of chronic heart failure in the population evaluated. Furthermore, there could be country-specific differences in health care systems or even education of physicians. Therefore, we suggest that similar studies should be performed in different countries and health care systems, because our results will not necessarily be valid in other countries.
Prescription of beta-blockers might be biased by higher prevalence of coronary artery disease (CAD) in male patients. However, all patients should be treated with a beta-blocker regarding their history of heart failure. Thus, CAD should not influence beta-blocker treatment. As we discussed in the manuscript, aetiology of heart failure was not documented in the study. There might have been a gender-related difference in the incidence of diastolic heart failure that may have had an influence on our results, but nevertheless, we evaluated ‘real-life’ treatment of patients by GPs or specialists.
The population of the study, as well as the design (cross sectional), was too small for evaluation of clinical outcomes. Several publications have demonstrated a similar clinical outcome for female and male patients with chronic heart failure. This could imply that female patients might have a better outcome than male patients when treated similarly. We agree that this suggestion cannot be concluded from our study, but might attract attention for future trials.
