Differences in medical treatment and clinical characteristics between men and women with heart failure – a single-centre multivariable analysis

Abstract

Purpose The aims of this study were to examine sex differences in a heart failure population with regards to treatment and patient characteristics and to investigate the impact of sex on achieved doses of heart failure medications. Methods and results A total of 1924 patients with heart failure in a regional hospital were analysed, 622 patients had ejection fraction ≤ 40% of which 30% were women. In patients with reduced ejection fraction, women were older (79 ± 11 vs. 74 ± 12 years, P < 0.001), had lower body weight (70 ± 17 vs. 86 ± 18 kg, P < 0.001), lower estimated glomerular filtration rate (eGFR) (49 ± 24 vs. 71 ± 30 ml/min, P < 0.001) and received lower doses of heart failure medications than men. Multivariable linear regression on patients with reduced ejection fraction showed that sex was not associated with achieved dose of any heart failure medication. For angiotensin-converting enzyme inhibitors and angiotensin receptor blockers associated factors were eGFR, systolic blood pressure, age, ejection fraction, and heart rate. For beta-blockers associated factors were body weight, atrial fibrillation and age. For mineralocorticoid receptor antagonists associated factors were eGFR, serum potassium, age, systolic blood pressure, ejection fraction and heart rate. Conclusion Women with heart failure and reduced ejection fraction were prescribed lower doses of heart failure medications, were older, had worse renal function, and lower body weight than men. Sex was not independently associated with achieved doses of heart failure medications, instead age, renal function and body weight explained the differences in treatment.

Implementation of sacubitril/valsartan in Sweden: clinical characteristics, titration patterns, and determinants

“…The remaining 43% patients who did not reach the target dose is probably a true reflection from real‐world clinical setting in which many of HF patients are generally a decade older with multiple co‐morbidities including renal failure, which is different from clinical trials where many severe co‐morbidities are excluded. This finding is in line with other HF therapies like ACEi/ARB or BB where various studies have highlighted that majority of the patients are not on guideline‐recommended target doses 16,17 and patients with higher age, lower body weight, and reduced kidney function are less likely to achieve target doses 18 . Furthermore, administration in twice daily may compromise compliance; however, it is difficult to believe that twice daily regimens alone are largely attributable to suboptimal up‐titration as many ACEi including enalapril and captopril are also administrated twice daily.…”

“…This finding is in line with other HF therapies like ACEi/ARB or BB where various studies have highlighted that majority of the patients are not on guideline-recommended target doses 16,17 and patients with higher age, lower body weight, and reduced kidney function are less likely to achieve target doses. 18 Furthermore, administration in twice daily may compromise compliance; however, it is difficult to believe that twice daily regimens alone are largely attributable to suboptimal up-titration as many ACEi including enalapril and captopril are also administrated twice daily. In a recent study from CHAMP-HF registry, only 10% of the patients received the recommended sac/val dose (49/51 mg) at the first prescription and less than half of all patients achieved the maximum target dose.…”

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

“…However, women have been historically included in a smaller proportion (around 30%) than men in clinical trials, and their therapeutic management and prognosis have been less studied. All this leads to a lower prescription in women of the treatments recommended by clinical practice guidelines [12,31,[40][41][42] and, for reasons not entirely clear, with lower average drug doses [9,[43][44][45]. Although information on drug doses used and on the LVEF of our patients were not available in our cohort, we confirmed, in general, the lower prescription of the specific treatments for HF in women.…”

Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population

“…It could be that women with HFrEF more often have renal dysfunction compared with men, and that renal dysfunction and other comorbidities are more abundant in the elderly. 31 Low blood pressure and orthostatic hypotension was the third most common reason for discontinuation, and systolic blood pressure remained an independent predictor for discontinuation in both of the multivariable logistic regression analyses. Reduced systolic blood pressure is an independent predictor of mortality in patients with HFrEF, however, MRA was shown to have the least hypotensive effect compared with other guideline-recommended medical treatments.…”

“…Further, female sex and elderly patients were more common in the discontinued MRA group, but these were not independent predictive factors for MRA discontinuation in the multivariable analysis. It could be that women with HFrEF more often have renal dysfunction compared with men, and that renal dysfunction and other comorbidities are more abundant in the elderly 31. Low blood pressure and orthostatic hypotension was the third most common reason for discontinuation, and systolic blood pressure remained an independent predictor for discontinuation in both of the multivariable logistic regression analyses.…”