Background Several studies have reported excess female mortality in patients with hypertrophic cardiomyopathy, but the cause is unknown. Aims To compare risk-factors for disease-related death in both sexes in a geographical cohort of patients with obstructive hypertrophic cardiomyopathy (oHCM). Methods and results Data-bases in all ten hospitals within West Götaland Region yielded 250 oHCM-patients (123 females, 127 males). Mean follow-up was 18.1 y. Risk-factors for disease-related death were evaluated by Cox-hazard regression and Kaplan-Meier survival-curves, with sex-comparisons of distribution of risk-factors and therapy in total and age-matched (n = 166) groups. At diagnosis females were older, median 62 y vs. 51 y, (P < 0.001), but not different in outflow-gradients and median NYHA-class. However, septal hypertrophy was more advanced: 10.6 [IQR = 3.2] vs. 9.6 [2.5] mm/m2 BSA; P = 0.002. Females had higher disease-related mortality than males (P = <0.001), with annual mortality 2.9% vs. 1.5% in age-matched groups (P = 0.010 log-rank). For each risk-category identified (NYHA-class ≥ III, outflow-gradient ≥50 mmHg), a higher proportion of females died (P = 0.0004; P = 0.001). Calcium-blocker therapy was a risk-factor (P = 0.005) and was used more frequently in females (P = 0.034). A beta-blocker dose above cohort-median reduced risk for disease-related death in both males (HR = 0.32; P = 0.0040) and in females (HR = 0.49; P = 0.020). Excess female deaths occurred in chronic heart-failure (P = 0.001) and acute myocardial infarctions (P = 0.015). Fewer females received beta-blocker therapy after diagnosis (64% vs. 78%, P = 0.018), in a smaller dose (P = 0.007), and less frequently combined with disopyramide (7% vs. 16%, P = 0.048). Conclusion Addressing sex-disparities in the timing of diagnosis and pharmacological therapy has the potential to improve the care of females with oHCM.
Background Data from previous studies indicate on increase in incidence of cardiomyopathies in Sweden. Another study confirmed high validity of diagnosis cardiomyopathy in western Sweden suggesting that a real increase in cardiomyopathy diagnosis might have occurred. Peripartum cardiomyopathy is a potentially dangerous condition that occurs few months before or up to five months after delivery. Purpose To assess incidence and mortality rates of women diagnosed with PPCM over last two decades in Sweden. Methods All women 18 to 50 years of age registered in the National Patient Register (NPR) in the period 1st January 1997 to 31st December 2019 were included. With the use of personal identification number (PIN), the data was than linked to other registers. Data on pregnancies were obtained from the Swedish Medical Birth Register (MBR) and data on the time of death and causes of death were gained from the Cause of Death Register. Women with PPCM were identified in the NPR using the international classification code for disease ICD-10 codes 090.3 as well as other coexisting conditions. The observation time was divided into fallowing periods: 1997–2001, 2002–2004, 2005–2007, 2008–2010, 2011–2013, 2014–2016 and 2017–2019. Results In total, over the period of 23 years we identified 2376988 deliveries. There were 23 women diagnosed with PPCM. The prevalence of women who received the diagnostic code for PPCM increased over time from 0.003% in the first time period to 0.012% in the last time period (Figure 1). In total 4.5% of women diagnosed with PPCM died during the observation time. Conclusion In this national, register-based study 187 women had diagnose PPCM. Total mortality over twenty years of time was low. Worryingly, we observed a four-fold increase in the use of diagnostic code for PPCM, suggesting an increse in incidence of PPCM over the last twenty-three years. More research is needed to investigate reasons for that. Funding Acknowledgement Type of funding sources: None.
Background Clinical phenotype and prognosis of heart failure (HF) may be variable among different racial populations. Therefore, a patient-level comparison of hospitalized HF patients in two university hospitals from China and Sweden was performed. Methods and results This study was a pooled data analysis of the patients prospectively enrolled in two single-center studies in China (n = 949) and Sweden (n = 1639) from 2011 to 2015. Clinical characteristics and 6-month all-cause mortality were collected. Higher systolic blood pressure (126.1 ± 20.3 vs. 114.2 ± 15.4 mmHg, p < 0.001) and NT-proBNP level (4540 vs. 3251 pg/mL, p = 0.013) were found in the Swedish cohort, also more patients with ischemic heart disease (32.0% vs. 19.2%), hypertension (64.2% vs. 36.8%), valvular heart disease (40.9% vs.31.6%) and atrial fibrillation (55.3% vs. 39.6%) (all p < 0.001). The use of ACEIs/ARBs (48.8% vs. 80.8%) or beta-blockers (58.8% vs. 86.5%) (both p < 0.001) was lower in Chinese cohort. Given younger age in Chinese cohort (61.6 vs. 76.4 years, p < 0.001), age-stratified analyses were conducted, as there were similar patient numbers in 50–74 years in Chinese (n = 550) and Swedish (n = 554) cohorts, therefore baseline characteristics and prognosis were further compared. The age- and sex-adjusted outcome (HR 0.80 [95% CI 0.55–1.19], p = 0.273) was comparable between the two populations. The NT-proBNP and eGFR independently predicted 6-month mortality in both Chinese (HR [95% CI] 1.006 [1.003–1.008], 0.986 [0.976–0.999]) and Swedish cohort (1.003 [1.000–1.007], 0.988 [0.976–0.999]). Conclusions Patient-level comparison of real-world HF populations from China and Sweden demonstrated different clinical phenotypes and therapy but similar prognosis and their predictors.
Background/Introduction Spontaneous coronary artery dissection (SCAD) is an acute myocardial event. Previous studies suggest female predominance. It is an unusual underlying cause of myocardial infarction. However, it is thought to be the most common cause of myocardial infarction associated with pregnancy. Purpose The aim of the study was to collect data on all women of reproductive age that had been diagnosed with SCAD in Sweden, including both pregnant and non-pregnant women, using the national Swedish health registers of the last two decades to describe the cohort and compare clinical characteristics. Methods Retrospective data on individuals with a diagnosis of SCAD (ICD-I25.4) occurring before fifty years of age were collected from four Swedish registers; the national patient register, the national medical birth register, the national cause of death register and the LISA register. Women diagnosed with SCAD between the years 1997 and 2019 and <50 years of age at diagnosis were included. SCAD during pregnancy or within 14 weeks post-partum was considered pregnancy-associated. Results A total of 75 women comprised the final cohort, seven of which met the criteria for pregnancy-associated SCAD. Nine percent of all women that had SCAD in Sweden before 50 years of age had it in association with pregnancy and in SCAD that occurred before 40 years of age, 28% arose in association with pregnancy. There were no clinically significant differences in height between women with pregnancy-associated SCAD and those with SCAD not associated with pregnancy. History of smoking, diabetes mellitus, hyperthyroidism, hypothyroidism and hyperlipidemia were not prominent in the cohort (9.3, 4, 1.3, 2.7 and 2.7% respectively). Seventeen percent of patients had had no pregnancies prior to first event of SCAD. Two patients (2.6%) were deceased due to ischemic heart disease, one had had SCAD associated with pregnancy. Conclusion Spontaneous coronary artery dissections are uncommon. However, when they do occur in women under forty years of age more than one in four (28%) is associated with pregnancy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish heart lung foundation.
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