Does Heart Failure Therapy Differ According to Patient Sex?

Abstract

SummaryObjectives: To assess differences in clinical characteristics, treatment and outcome between men and women with heart failure (HF) treated at a multidisciplinary HF unit. All patients had their first unit visit between August 2001 and April 2004.Patients: We studied 350 patients, 256 men, with a mean age of 65 ± 10.6 years. In order to assess the pharmacological intervention more homogeneously, the analysis was made at one year of follow-up.Results: Women were significantly older than men (69 ± 8.8 years vs. 63.6 ± 10.9 years, p < 0.001). Significant differences were found in the HF etiology and in co-morbidities. A higher proportion of men were treated with ACEI (83% vs. 68%, p < 0.001) while more women received ARB (18% vs. 8%, p = 0.006), resulting in a similar percentage of patients receiving either of these two drugs (men 91% vs. women 87%). No significant differences were observed in the percentage of patients receiving beta-blockers, loop diuretics, spironolactone, anticoagulants, amiodarone, nitrates or statins. More women received digoxin (39% vs. 22%, p = 0.001) and more men aspirin (41% vs. 31%, p = 0.004). Carvedilol doses were higher in men (29.4 ± 18.6 vs. 23.8 ± 16.4, p = 0.03), ACEI doses were similar between sexes, and furosemide doses were higher Mortality at 1 year after treatment analysis was similar between sexes (10.4% men vs. 10.5% women).Conclusions: Despite significant differences in age, etiology and co-morbidities, differences in treatment between men and women treated at a multidisciplinary HF unit were small. Mortality at 1 year after treatment analysis was similar for both sexes.

Pacientes con el diagnóstico de insuficiencia cardiaca en Atención Primaria: envejecimiento, comorbilidad y polifarmacia

“…En cuanto a patología asociada y por sexos, los resultados coinciden con la literatura 20,[21][22][23][24] en la mayor presencia de HTA en mujeres y menor de CI, tabaquismo y asma/EPOC pero no en cuanto a la de DM2, FA, IR, DL, donde existen resultados discordantes posiblemente por que, en la mayoría de ellos, los pacientes proceden de ingresos hospitalarios o de unidades multidisciplinarias ubicadas en hospitales. Nuestros resultados se aproximan más a los del estudio GALICAP 15 que también está realizado en AP.…”

“…Lupón J et al 24 sugieren que la mayor indicación de digoxina en la mujer podría explicarse por su mayor frecuencia de FA, pero en nuestra serie la mujer no presenta mayor prevalencia de FA a pesar de recibir mayor prescripción de glucósidos cardíacos.…”

“…Aceptando esta definición, encontramos gran comorbilidad y dado que las situaciones mórbidas seleccionadas son limitadas, probablemente sea mayor. Aunque en general otros estudios encuentran una mayor comorbilidad asociada en las mujeres 23,24 , en nuestra serie no se ha confirmado.…”

Influence of Sex on Treatment and Outcome in Chronic Heart Failure

“…This is important as both trial [26] and registry data [27] indicate that women do suffer more side effects from ACE‐I, and might explain the observed treatment imbalances for ACE‐I between the sexes. Yet, when patients had been treated at a multidisciplinary heart failure unit, treatment differences between the sexes were negligible despite significant differences in age, etiology, and comorbidities [28], a finding we were recently able to reproduce [29].…”

“…This finding confirms data from the OPTIMIZE‐HF registry [56] in which female patients generally received similar medical care to males and had similar risks of adverse clinical outcomes after discharge. In fact, equal treatment seems to be the key point: women and men treated in a specialized heart failure unit [28], as well as those on optimal medical therapy in a community setting [57], had the same prognosis.…”