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Heart Failure
(35%). Woman had higher systolic blood pressure (140 versus 130mmHg; follow-up period. When the age difference between men and women
p<0.001), while diastolic blood pressure was the same (80mmHg for both was adjusted for, male gender was associated with an increased risk
sexes). Echocardiography results were available in the majority of patients of death (relative risk [RR] 1.25, 1.17–1.34).
enrolled in EHFS II. Median left ventricular end-diastolic diameter was
smaller (53 versus 60mm) and ejection fraction was significantly higher In the US, the Organized Program to Initiate Life-saving Treatment in
(43.7 versus 35.1%) in women. The baseline data from EHFS II confirm all Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry included
the significant findings from the AHEAD registry. 48,312 patients with AHF. Mean age was 73.1 years, 52% were women,
74% were Caucasian, and 46% had ischemic etiology;
12
in-hospital
There were no gender-related differences in the use of continuous mortality occurred in 1,834 (3.8%). Multivariable predictors of mortality
positive airway pressure mask or mechanical ventilation; however, included advanced age, high heart rate, low systolic blood pressure,
inotropic agents and levosimendan were less often prescribed to female low sodium, and high creatinine. The US national registry, Acute
patients than to male patients.
9
In-hospital mortality was 6.6% in Decompensated Heart Failure National Registry (ADHERE), reported data
all patients without any significant difference between the genders. from the first 105,388 patients in 2006.
13
Women accounted for 52% of
Mean length of stay in hospital was nine days for both genders (female these admissions and were older than men (74.5 versus 70.1 years) and
patients 10.1 days, male patients 9.7 days). There was no gender more commonly had preserved left ventricular function (51 versus 28%).
difference in the proportion of re-hospitalizations for HF after follow-up at Based on history, women were less likely to have coronary artery disease
three months. The length of stay in hospital is similar in the AHEAD and (51 versus 64%) and its risk factors, but more commonly had
EHFS II registries, and in-hospital mortality is significantly higher in the hypertension (76 versus 70%). Both genders received similar intravenous
AHEAD registry, probably due to the concentration of acute coronary diuretic regiments, but fewer women received vasoactive therapy
syndromes in the specialized university departments with catheterization (24 versus 31%). Mean length of stay (women 5.9 days, men 5.8 days) and
laboratories. Acute coronary syndromes and/or pulmonary embolism with the risk-adjusted in-hospital mortality was similar in both genders. Of
HF were associated with high mortality in the AHEAD registry. 2002, we followed for five years all patients hospitalized at the Internal
Cardiology Department of the University Hospital St Ann in Brno.
14
From
Ritter performed a prospective observational study evaluating gender 2,346 hospitalized patients, 320 (13.6%) suffered from chronic HF and 28
differences among 217 AHF patients (124 men and 93 women).
10
(1.2%) died during hospitalization. The in-hospital mortality rate was
Women were older (78±13 versus 72±10 years) and had less similar to that not suffering from chronic HF (p=0.3). Women with HF
pulmonary comorbidity but more noticeable jugular venous were older and had higher systolic blood pressure and ejection fraction.
distension, as well as lower systolic and diastolic blood pressure and Of 292 patients who were discharged, 162 (55%) died during the next five
higher ejection fraction (44±14 versus 38±17%). Among contributing years. The pre-determined parameters of pure prognosis were low
causes of acute CHF, myocardial ischemia, and anemia were more diastolic blood pressure (p=0.008), low cholesterol (p=0.012), and high
frequent in women. The initial outcome, including 30-day mortality, creatinin (p=0.009), and there were no gender differences.
time to discharge, and total treatment cost, was not different between
women and men. Important differences were noted during long- Conclusion
term follow-up. Mean cumulative survival was 619 days in women More men than women (60:40) are hospitalized with AHF. Only the US
compared with 669 days in men (p=0.0663); however, after multivariate registries—ADHERE and OPTIMIZE-HF—had slightly more female patients
adjustment female gender was not an independent predictor of long- (52% in both trials). Women are five to six years older than men when
term mortality. Conversely, in the Dispensibility Improvement And admitted with HF: the mean age of women is 73–75 years while that of
Remodeling in Diastolic Heart Failure study (DIAMOND) study from men is 68–70 years. Women have higher systolic blood pressure—mean
Denmark, female sex was associated with better long-term survival in systolic blood pressure is 140mmHg for women and 130mmHg for men—
patients hospitalized with congestive HF.
11
Survival analysis included while diastolic blood pressure is about 80mmHg for both sexes. HF with
5,491 consecutive patients admitted with congestive HF to 34 Danish preserved left ventricular function predominates in women: mean ejection
hospitals between 1993 and 1996; follow-up time was five to eight fraction is slightly over 40% in women and slightly less than 40% in men.
years. Women were older (75 versus 72 years), had less evidence of Men more frequently have obstructive lung disease, while women more
ischemic heart disease (53 versus 59%), and their ventricular systolic frequently have anemia. Although women are treated less aggressively,
function was preserved to a greater extent than in males (wall-motion treatment gaps exists in both sexes. Despite these differences, length of
index 1.6 versus 1.2; p<0.01). One thousand, five hundred and sixty- stay and in-hospital mortality rates are similar, but if adjusted for age, male
nine of the women (72%) and 2,386 of the men (72%) died during the gender is associated with an increased risk for death. n
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