{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:51:55Z","timestamp":1778777515341,"version":"3.51.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2302,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T00:00:00Z","timestamp":1571184000000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Baker Brightsparks Top-up Scholarship"},{"name":"National Heart Foundation Postgraduate Scholarship"},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate\u2013severe heart failure with reduced ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We recruited 452 consecutive class II\u2013III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74\u20131.92, 0.48). There was no difference in prescription of beta-blockers [\u03c72(1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [\u03c72(1) = 0.001, 0.97], nor aldosterone antagonists [\u03c72(1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [\u03c72(1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12481","type":"journal-article","created":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T18:31:55Z","timestamp":1571250715000},"page":"944-952","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of Sex, Socio-Economic Status, and Remoteness on Therapy and Survival in Heart Failure"],"prefix":"10.1093","volume":"6","author":[{"given":"Sarah J.","family":"Gutman","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Baker Heart and Diabetes Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben T.","family":"Costello","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Baker Heart and Diabetes Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavroula","family":"Papapostolou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Iles","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnson","family":"Ja","sequence":"additional","affiliation":[{"name":"The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James L.","family":"Hare","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Baker Heart and Diabetes Institute , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andris","family":"Ellims","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas H.","family":"Marwick","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Baker Heart and Diabetes Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, Victoria ,","place":["Australia"]},{"name":"Baker Heart and Diabetes Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"key":"2026012115085113700_ehf212481-bib-0001","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jchf.2018.04.003","article-title":"Health status equity: a right not a privilege","volume":"6","author":"Breathett","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026012115085113700_ehf212481-bib-0002","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1001\/jama.2009.1227","article-title":"Sex differences in mortality following acute coronary syndromes","volume":"302","author":"Berger","year":"2009","journal-title":"JAMA"},{"key":"2026012115085113700_ehf212481-bib-0003","doi-asserted-by":"crossref","first-page":"118","DOI":"10.5694\/mja17.01109","article-title":"Differences in management and outcomes for men and women with ST-elevation myocardial infarction","volume":"209","author":"Khan","year":"2018","journal-title":"Med J Aust"},{"key":"2026012115085113700_ehf212481-bib-0004","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1161\/CIRCULATIONAHA.118.034271","article-title":"Sex differences in cardiovascular pathophysiology: why women are overrepresented in heart failure with preserved ejection fraction","volume":"138","author":"Beale","year":"2018","journal-title":"Circulation"},{"key":"2026012115085113700_ehf212481-bib-0005","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1002\/ejhf.67","article-title":"Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction","volume":"16","author":"Gori","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2026012115085113700_ehf212481-bib-0006","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1161\/01.CIR.99.14.1816","article-title":"Gender differences in survival in advanced heart failure. Insights from the FIRST study","volume":"99","author":"Adams","year":"1999","journal-title":"Circulation"},{"key":"2026012115085113700_ehf212481-bib-0007","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1001\/jamacardio.2018.2559","article-title":"Enrollment of older patients, women, and racial and ethnic minorities in contemporary heart failure clinical trials: a systematic review","volume":"3","author":"Tahhan","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2026012115085113700_ehf212481-bib-0008","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","article-title":"A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010","volume":"175","author":"Gerber","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2026012115085113700_ehf212481-bib-0009","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.hfc.2018.08.003","article-title":"Heart failure with reduced ejection fraction in women: epidemiology, outcomes, and treatment","volume":"15","author":"Mentzer","year":"2019","journal-title":"Heart Fail Clin"},{"key":"2026012115085113700_ehf212481-bib-0010","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/ehjcvp\/pvw042","article-title":"Gender differences in the effects of cardiovascular drugs","volume":"3","author":"Tamargo","year":"2017","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2026012115085113700_ehf212481-bib-0011","volume-title":"Fact sheet: women & socioeconomic status","author":"Association AP"},{"key":"2026012115085113700_ehf212481-bib-0012","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1093\/eurjhf\/hfr168","article-title":"Heart failure and socioeconomic status: accumulating evidence of inequality","volume":"14","author":"Hawkins","year":"2012","journal-title":"Eur J Heart Fail"},{"key":"2026012115085113700_ehf212481-bib-0013","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.hlc.2012.04.012","article-title":"Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand","volume":"21","author":"Wilson","year":"2012","journal-title":"Heart Lung Circ"},{"key":"2026012115085113700_ehf212481-bib-0014","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.hfc.2015.07.011","article-title":"Heart failure in rural communities","volume":"11","author":"Verdejo","year":"2015","journal-title":"Heart Fail Clin"},{"key":"2026012115085113700_ehf212481-bib-0015","doi-asserted-by":"crossref","DOI":"10.1093\/eurheartj\/ehy564.P269","article-title":"Reduction in mortality from implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy patients is dependent on the presence of left ventricular scar","volume":"39","author":"Gutman","year":"2018","journal-title":"Eur Heart J"},{"key":"2026012115085113700_ehf212481-bib-0016","volume-title":"Socio-Economic Indexes for Areas (SEIFA)","author":"Pink"},{"key":"2026012115085113700_ehf212481-bib-0017","volume-title":"Measuring remoteness: Accessibility\/Remoteness Index of Australia (ARIA)","author":"Health TAGDo","year":"2001"},{"key":"2026012115085113700_ehf212481-bib-0018","doi-asserted-by":"crossref","first-page":"549","DOI":"10.5694\/j.1326-5377.2006.tb00690.x","article-title":"Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006","volume":"185","author":"Krum","year":"2006","journal-title":"Med J Aust"},{"key":"2026012115085113700_ehf212481-bib-0019","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1056\/NEJMoa020265","article-title":"Long-term trends in the incidence of and survival with heart failure","volume":"347","author":"Levy","year":"2002","journal-title":"N Engl J Med"},{"key":"2026012115085113700_ehf212481-bib-0020","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/0002-9149(93)90355-G","article-title":"Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. The Italian Multicenter Cardiomyopathy Study Group (SPIC)","volume":"72","author":"De Maria","year":"1993","journal-title":"Am J Cardiol"},{"key":"2026012115085113700_ehf212481-bib-0021","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.1161\/CIRCULATIONAHA.106.673442","article-title":"Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program","volume":"115","author":"O'Meara","year":"2007","journal-title":"Circulation"},{"key":"2026012115085113700_ehf212481-bib-0022","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jacc.2018.09.081","article-title":"Differential impact of heart failure with reduced ejection fraction on men and women","volume":"73","author":"Dewan","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026012115085113700_ehf212481-bib-0023","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1001\/jama.292.3.344","article-title":"Trends in heart failure incidence and survival in a community-based population","volume":"292","author":"Roger","year":"2004","journal-title":"JAMA"},{"key":"2026012115085113700_ehf212481-bib-0024","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.ahj.2008.12.016","article-title":"Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF","volume":"157","author":"Yancy","year":"2009","journal-title":"Am Heart J"},{"key":"2026012115085113700_ehf212481-bib-0025","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S0195-668X(02)00700-5","article-title":"The EuroHeart Failure Survey programme\u2014a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment","volume":"24","author":"Komajda","year":"2003","journal-title":"Eur Heart J"},{"key":"2026012115085113700_ehf212481-bib-0026","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1089\/jwh.2014.4980","article-title":"Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events","volume":"24","author":"Herz","year":"2015","journal-title":"J Womens Health (Larchmt)"},{"key":"2026012115085113700_ehf212481-bib-0027","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1001\/jama.298.13.1525","article-title":"Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure","volume":"298","author":"Hernandez","year":"2007","journal-title":"JAMA"},{"key":"2026012115085113700_ehf212481-bib-0028","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1161\/CIRCULATIONAHA.115.021048","article-title":"Sex and race\/ethnicity differences in implantable cardioverter-defibrillator counseling and use among patients hospitalized with heart failure: findings from the Get With The Guidelines-Heart Failure Program","volume":"134","author":"Hess","year":"2016","journal-title":"Circulation"},{"key":"2026012115085113700_ehf212481-bib-0029","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jchf.2018.02.002","article-title":"Health status disparities by sex, race\/ethnicity, and socioeconomic status in outpatients with heart failure","volume":"6","author":"Khariton","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026012115085113700_ehf212481-bib-0030","first-page":"341","article-title":"Cardiovascular medication utilization and adherence among heart failure patients in rural and urban areas: a retrospective cohort study","volume":"31","author":"Murphy","year":"2015","journal-title":"Can J Cardiol"},{"key":"2026012115085113700_ehf212481-bib-0031","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1056\/NEJMoa1100356","article-title":"Coronary-artery bypass surgery in patients with left ventricular dysfunction","volume":"364","author":"Velazquez","year":"2011","journal-title":"N Engl J Med"},{"key":"2026012115085113700_ehf212481-bib-0032","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/j.jacc.2006.11.041","article-title":"Associations of gender and etiology with outcomes in heart failure with systolic dysfunction: a pooled analysis of 5 randomized control trials","volume":"49","author":"Frazier","year":"2007","journal-title":"J Am Coll Cardiol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fehf2.12481","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.12481","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.12481","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/5\/944\/66136225\/eschf_6_5_944.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/5\/944\/66136225\/eschf_6_5_944.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:11:18Z","timestamp":1769026278000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/6\/5\/944\/8403510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,10,16]]},"published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.12481","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,10,1]]},"assertion":[{"value":"2019-02-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}