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Heart Failure
Gender Differences in the Acute HEArt Database Registry
Jindrich Spinar, MD, PhD
1,2
and Lenka Spinarová, MD, PhD
1,3
1. Acute HEArt Database (AHEAD) Investigators, Internal Cardiology Department, University Hospital, Brno;
2. Medical Faculty, Masaryk University, Brno; 3. Moravian Heart Transplant Program
Abstract
Acute heart failure (AHF) is a major and growing cause of in-hospital mortality in developed countries. Differences between males and females
hospitalized for AHF were observed in all registries and clinical studies. In this article, we compare data from European registries—the Acute
HEArt Database (AHEAD), the EuroHeart Failure Survey program II (EHFS II), and the Dispensibility Improvement And Remodeling in Diastolic
Heart Failure (DIAMOND) study—and US registries—the Acute Decompensated Heart Failure National Registry (ADHERE) and the Organized
Program to Initiate Life-saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Women are older than men when admitted
with HF in all registries: the mean age of women is 73–75 years and the mean age of men is 68–70 years. Women have higher systolic blood
pressure—the mean systolic blood pressure is about 140mmHg for women and 130mmHg for men—while diastolic blood pressure is about
80mmHg for both sexes. HF with preserved left ventricular function predominates in women: the mean ejection fraction is about 43% in women
and approximately 38% in men. Men have obstructive lung disease more often, while women more frequently have anemia. Despite these
differences, length of stay and in-hospital mortality rates are similar but, if adjusted for age, male gender is associated with an increased risk
for death.
Keywords
Acute heart failure, gender differences, age, blood pressure, mortality
Disclosure: Jindrich Spinar, MD, PhD, is a consultant for Abbott, sanofi-aventis, and KRKA. Lenka Spinarová, MD, PhD, is a consultant for Abbott and Astellas. The AHEAD registry is
supported by a Czech Republic Ministry of Health grant 1A – 8606-5.
Received: June 16, 2009 Accepted: October 5, 2009
Correspondence: Jindrich Spinar, MD, PhD, Internal Cardiology Department, University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic. E: jspinar@fnbrno.cz
Acute heart failure (AHF) is a major and growing cause of in-hospital hundred and forty-five patients were included: 903 females (40.2%) and
mortality in developed countries. The prevalence of HF in an unselected 1,342 males (59.8%). Mean age, body mass index, blood pressure,
population >45 years of age is estimated to be 2% and in a population and ejection fraction at admission are shown in Table 1. The duration
>65 years of age is estimated to be 8.8%.
1,2
The combination of aging of of hospitalization was nine days in women and 9.1 days in men
the population in many countries and improved survival after acute (p=NS). In-hospital mortality was 11.1% in women and 12% in men (p=NS).
myocardial infarction has created rapid growth in the number of patients Baseline characteristics according to etiology of HF and mortality data are
currently living with chronic heart failure, with a concomitant increase in shown in Table 2 (all data are NS for gender differences). Biochemistry
the number of hospitalizations for decompensated HF.
3–5
Coronary heart parameters at baseline are shown in Table 3.
disease is the etiology of AHF in 60–70% of patients, particularly in the
elderly population.
6,7
AHF is defined as the rapid onset of symptoms and The most important gender differences in the AHEAD registry are that
signs secondary to abnormal cardiac function.
3
It may occur with or women hospitalized for AHF are significantly older and slightly more
without previous cardiac disease. Little is known about sex differences in frequently have de novo HF with elevated systolic blood pressure and
baseline characteristics and outcomes in patients with AHF. higher ejection fraction than males. Females frequently have more anemia,
and less frequently have renal insufficiency. In-hospital mortality is similar,
The Acute HEArt failure Database (AHEAD) program consists of the but if adjusted for age the prognosis of female patients is clearly better.
AHEAD MAIN, AHEAD CORE (single-center extended registry), and AHEAD
NETWORK (including hospitals without catheterization laboratory studies). Patients enrolled in clinical trials are usually younger, are more
AHEAD MAIN included patients hospitalized from July 2006 to December frequently men, have fewer comorbidities, are properly treated, and
31, 2008 in five university hospitals, all of which had a 24-hour have better prognosis than real-life patients. Therefore, data from
catheterization laboratory service. All data were prospectively collected international and/or national registries more accurately reflect reality
using an Internet program (www.ahead.registry.cz). Two thousand, two and can provide important information about the subject.
64 © TOUCH BRIEFINGS 2009