Guiding Equal Heart Failure Care
Study finds new strategy for heart failure care is equally effective for males and females.
Heart failure can look different in male and female patients, with different underlying factors, symptom burden, and hospitalization rates. Therefore, it is important to determine whether emergency department approaches to acute heart failure management are effective for these different patient populations.
Heart failure is one of the leading causes of illness and mortality worldwide. The care strategy used by emergency departments to manage heart failure can significantly impact patient outcomes. A recent UHN-led study found that a new strategy used to manage patients with this condition is equally effective for male and female populations.
When patients come to the emergency room with heart failure, it can be difficult to determine whether they need to be admitted or can safely be discharched. Discharging high-risk patients too early can lead to serious complications or death. A major Canadian trial (the COACH trial) co-led by UHN’s Dr. Douglas Lee showed that using a structured risk assessment tool and providing rapid follow-up care after discharge can improve outcomes—but it was unclear whether these benefits were the same for males and females.
Although male and female patients have a similar lifetime risk of developing heart failure, female patients often face a higher burden of symptoms, lower quality of life, and more hospital readmissions despite lower rates of hospitalization overall. Some research has also suggested that females may be more likely than males to be readmitted to hospital for heart failure within a year of discharge.
Because of this disparity in outcomes with the current standard of care, researchers wanted to know whether the COACH trial strategy works equally well for both males and females.
Researchers analyzed data from more than 5,400 patients treated across 10 hospitals in Ontario between 2017 and 2019 as part of the COACH clinical trial.
After a follow-up period of both 30 days and 20 months, both male and female patients saw similar outcomes. For both patient groups, the strategy in the COACH trial led to modest reductions in the combined risk of death or heart-related hospitalization, with no meaningful difference between sexes.
Overall, the findings suggest that using risk-based decision tools in the emergency department, combined with coordinated follow-up care, can benefit heart failure patients regardless of sex. These results support the application of this care model broadly, offering more patients with heart failure improved outcomes.
Dr. Douglas Lee is the Division Head of Cardiology and a Senior Scientist at UHN’s Peter Munk Cardiac Centre, and a Professor in the Department of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto. He is also a Senior Core Scientist at ICES and the Ted Rogers Chair in Heart Function Outcomes at the Ted Rogers Centre for Heart Health. He is the first and corresponding author of the study.
Dr. Heather Ross is a Clinician Scientist at UHN's Peter Munk Cardiac Centre, the Loretta Rogers Chair in Heart Function at UHN, and a Professor of Medicine at the University of Toronto. She is a co-senior author of the study.
This work was supported by the Ontario SPOR Support Unit, the Ted Rogers Centre for Heart Research, the Canadian Institutes of Health Research, ICES, the Ontario Ministry of Health (MOH) and Ministry of Long-Term Care, and UHN Foundation.
For a list of competing interests, see the manuscript.
Lee DS, Wang CN, Austin PC, Straus SE, Farkouh ME, Chong A, Taljaard M, Poon S, Smith S, McKelvie RS, Iwanochko RM, MacDougall A, Elbarasi E, Cram PM, Fang J, Atzema CL, Udell JA, Rochon PA, Schull MJ, Mak S, Ross HJ. Risk-Stratified Transitional Care and Cardiovascular Hospitalizations by Sex: A Secondary Analysis of a Randomized Clinical Trial.JAMA Netw Open. 2026 May 1. doi: 10.1001/jamanetworkopen.2026.11892.