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

Abstract

Heart failure (HF) is becoming increasingly prevalent and affects both men and women. However, women have traditionally been underrepresented in HF clinical trials. In this study, we aimed to analyze sex differences in the comorbidity, therapy, and health services’ use of HF patients. We conducted a cross-sectional study in Aragón (Spain) and described the characteristics of 17,516 patients with HF. Women were more frequent (57.4 vs. 42.6%, p < 0.001) and older (83 vs. 80 years, p < 0.001) than men, and presented a 33% lower risk of 1-year mortality (p < 0.001). Both sexes showed similar disease burdens, and 80% suffered six or more diseases. Some comorbidities were clearly sex-specific, such as arthritis, depression, and hypothyroidism in women, and arrhythmias, ischemic heart disease, and COPD in men. Men were more frequently anti-aggregated and anti-coagulated and received more angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers, whereas women had more angiotensin II antagonists, antiinflammatories, antidepressants, and thyroid hormones dispensed. Men were admitted to specialists (79.0 vs. 70.6%, p < 0.001), hospital (47.0 vs. 38.1%, p < 0.001), and emergency services (57.6 vs. 52.7%, p < 0.001) more frequently than women. Our results highlight the need to conduct future studies to confirm the existence of these differences and of developing separate HF management guidelines for men and women that take into account their sex-specific comorbidity.

Factors Influencing Background Incidence Rate Calculation: Systematic Empirical Evaluation Across an International Network of Observational Databases

“…Patient characteristics such as age ( Lin et al, 2011 ; Sejvar et al, 2011 ; Dodd et al, 2018 ; Willame et al, 2021 ), sex ( Linn et al, 1996 ; Hanratty, 2000 ; Gracia Gutiérrez et al, 2020 ; Willame et al, 2021 ), race ( Kanaya et al, 2011 ; Idrees et al, 2018 ; Huang et al, 2020 ), patient location ( Linn et al, 1996 ; Dodd et al, 2018 ; Idrees et al, 2018 ; Marty et al, 2018 ) and primary healthcare institution ( Beghi et al, 2011 ; Lin et al, 2011 ; Cologne et al, 2019 ; Willame et al, 2021 ) have been shown to have an impact on the IRs. For example, the studies reported up to a 10-fold difference in IRs of adverse events in different age groups ( Black et al, 2009 ), up to a 20-fold difference in IRs across different data sources ( Willame et al, 2021 ).…”

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

“…Accordingly, the prevalence of HF and COPD increased in men and with age, likely because older patients are generally affected by additional comorbidities ( 50 , 51 ), compared to patients affected by HF alone ( 49 , 51 – 54 ). The high prevalence in men might be due to their increased aptitude to smoke ( 55 ); moreover, women have different symptoms and clinical presentation of COPD, and this could lead to an underdiagnosis in women; additionally, the diagnosis of COPD is often mainly difficult in HF with preserved ejection fraction, which most often affects women ( 56 , 57 ).…”

Age and gender differences in diagnostic decision-making of early heart failure: results of a mixed-methods interview-study using video vignettes

“…Although the average of HF prevalence and incidence shows only a slight difference between men and women in Germany, GPs seem to be sensitised for HF in older women affecting the diagnosis and the certainty about it. This might be due to three reasons: first, patients with HF treated by GPs alone, instead of cardiologists, are often older and female34 35; second, the rise of HF prevalence in women at age of 80 years compared with men36; and third, a greater awareness of poor recognition of heart diseases in women over the last decades in general 37. In the past, HF was classified as men-specific disease, assuming a hormone-related protection for premenopausal women,37 38 which can be rebutted by more recent studies 5 6 36.…”