| Peer-Reviewed

Sex Differences in Characteristics and Management of Patients with Acute Heart Failure

Received: 21 May 2017     Accepted: 1 June 2017     Published: 24 July 2017
Views:       Downloads:
Abstract

Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay and mortality was found between sexes. Hypertensive (26.8% vs 19.8%, p = 0.02) and valvular (13.6% vs 8.6%, p = 0.03) were the more prevalent etiologies of HF in females, while ischemic heart disease was in males (25.8% vs 18.2%, p = 0.01). HF with a preserved left ventricle ejection fraction (LVEF) was significantly more prevalent in females compared to males (51.3% vs 32.6%, p = 0.0001). Chronic obstructive pulmonary disease (COPD), peripheral artery diseases (PAD) and severe anemia were more frequent in males, while cognitive impairment was in females. Mean creatinine clearance at hospital admission was lower in females than in males (44.4 ± 22.2 vs 49.4 ± 26.3 ml/min, p < 0.05). Females received more frequently non invasive ventilation compared to males (15.1% vs 9.1%, p = 0.011). No difference between sexes was registered in the use of diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers and digoxin, whereas the use of anti-aldosterone agents, ivabradine and statins were more frequently used in males. No difference between sexes was found in the median number of drugs prescribed at hospital discharge [8 (interquartile range, IQR, 6-11) vs 9 (IQR 7-11)]. Eighty-two percent of females and seventy-nine percent of males were discharged at home (p = ns). Fifty-six percent of females compared with forty percent of males were dependent in activities of daily living at hospital discharge (p = 0.0001). The present study demonstrates that demographic characteristics, etiology, co-morbidity and echocardiographic pattern of HF differ according to sex. Further prospective study are warranted.

Published in Cardiology and Cardiovascular Research (Volume 1, Issue 3)
DOI 10.11648/j.ccr.20170103.13
Page(s) 84-90
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Heart Failure, Gender, Management, Prognosis, Drugs

References
[1] Roger VL, Weston SA, Redfield MM et al. Trends in heart failure incidence and survival in a community-based population. JAMA 2004; 292: 344-350.
[2] Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol 2016; 13: 368-78.
[3] Levy D, Kenchaiah S, Larson MG et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002; 347: 1397-1402.
[4] Tran DT, Ohinmaa A, Thanh NX, Howlett JG, Ezekowitz JA, McAlister FA, Kaul P. The current and future financial burden of hospital admissions for heart failure in Canada: a cost analysis. CMAJ Open. 2016; 4: E365-E370.
[5] Voigt J, Sasha John M, Taylor A, Krucoff M, Reynolds MR, Michael Gibson C. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States. Clin Cardiol 2014; 37: 312-21.
[6] Hsich, E M, Piña, I L. Heart Failure in Women A Need for Prospective Data. J Am Coll Cardiol 2009; 54: 491–8.
[7] CrespoLeiro MG, Paniagua Martin MJ. Heart Failure. Are women different?. Rev Esp Cardiol 2006; 59: 725-735.
[8] Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP, ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart failure National Registry (ADHERE). Am Heart J 2005; 149: 209-216.
[9] Shah R U, Klein L, Lloyd-Jones DM. Heart Failure in Women: Epidemiology, Biology and TreatmentWomen's Health. 2009; 5: 517-527.
[10] Verdiani V, Panigada G, Fortini A, Masotti L, Meini S, Biagi P. The Heart Failure in Internal Medicine in Tuscany: the SMIT Study. Ital J Med 2015; 9: 349-55.
[11] Yancy CW, Jessup M, Bozkurt B, Butler J et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. A Report of the American College of Cardiology Foundation / American Heart Association Task Forceon Practice Guidelines. Circulation2013; 128: e240-e327.
[12] Shah RU, Klein L, Lloyd-Jones DM. Heart failure in women: epidemiology, biology and treatment. Women’s Health 2009; 5: 517-527.
[13] Mozzafarian D, Benjamin EJ Go AS, Arentt DK et al. Heart disease and stroke statistics- 2015 update: a report from the America Heart Association. Circulation 2015; 131: e29-322.
[14] Piro M, Della Bona R, Abbata A, Biasucci LM, Crea F. Sex-related Differences in Myocardial remodeling JACC 2010; 55: 1057-1064.
[15] Nakada Y, Kawakami R, Nakano T et al. Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction. Am J Physiol Heart Circ Physiol 2016; 310: H813-20.
[16] Meyer S, Teerlink JR, Metra M et al. Sex differencesin early dyspnea relief between men and women hospitalized for acute heart failure: insights from the RELAX-AHF study. Clin Res Cardiol 2016 [Epub ahead of print].
[17] Meyer S, van der Meer P, Massie BM et al. Sex-specific acute heart failure phenotypes and outcomes from PROTECT. Eur J Heart Fail 2013; 15: 1374-81.
[18] Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996; 275: 1557e62.
[19] Rosano GM, Vitale C, Mercuro G. The metabolic syndrome in women. Womens Health (Lond Engl) 2006; 2: 889–898.
[20] Thomas KL, Velazquez EJ. Therapies to prevent heart failure post-myocardial infarction. Curr Heart Fail Rep 2005; 2: 174e82.)
[21] Bibbins-Domingo K, Lin F, Vittinghoff E et al. Predictors of heart failure among women with coronary disease. Circulation 2004; 110: 1424e30).
[22] Massie BM, Carson PE, McMurray JJ, et al, for the I-PRESERVE Investigators. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 2008; 359: 2456-67.
[23] Lam CS, Carson PE, Anand IS, Rector TS et al. Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ Heart Fail 2012; 5: 571-8.
[24] Gori M, Lam CSP, Gupta DK et al. Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014; 16: 535-542).
[25] Young JB, Dunlap ME, Pfeffer MA, Probstfield JL, Cohen-Solal A, Dietz R, Granger CB, Hradec J, Kuch J, McKelvie RS, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Held P, Solomon SD, Yusuf S, Swedberg K, (CHARM Investigators and Committees). Circulation 2004; 110: 2618-2624.
[26] Fonarow GC, Albert NM, Curtis AB, Stough WG, Gheorghiade M, Heywood JT, McBride ML, Inge PJ, Mehta MR, O’Connor CM, Reynolds D, Walsh MN, Yancy CW. Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF). Circulation 2010; 122: 585-596.
[27] Lenzen MJ, Rosengren A, Scholte op Reimer WJ, Follath F, Boersma E, Simoons ML, Cleland JGF, Komajda M. Management of patients with heart failure in clinical practice: differences between men and women. Heart 2008; 94: e10.
[28] Metha PA, Cowie MR. Gender and heart failure: a population perspective. Heart 2006; 92 (Suppl III): 14-18.
Cite This Article
  • APA Style

    Paolo Biagi, Valerio Verdiani, Grazia Panigada, Vieri Vannucchi, Luca Masotti, et al. (2017). Sex Differences in Characteristics and Management of Patients with Acute Heart Failure. Cardiology and Cardiovascular Research, 1(3), 84-90. https://doi.org/10.11648/j.ccr.20170103.13

    Copy | Download

    ACS Style

    Paolo Biagi; Valerio Verdiani; Grazia Panigada; Vieri Vannucchi; Luca Masotti, et al. Sex Differences in Characteristics and Management of Patients with Acute Heart Failure. Cardiol. Cardiovasc. Res. 2017, 1(3), 84-90. doi: 10.11648/j.ccr.20170103.13

    Copy | Download

    AMA Style

    Paolo Biagi, Valerio Verdiani, Grazia Panigada, Vieri Vannucchi, Luca Masotti, et al. Sex Differences in Characteristics and Management of Patients with Acute Heart Failure. Cardiol Cardiovasc Res. 2017;1(3):84-90. doi: 10.11648/j.ccr.20170103.13

    Copy | Download

  • @article{10.11648/j.ccr.20170103.13,
      author = {Paolo Biagi and Valerio Verdiani and Grazia Panigada and Vieri Vannucchi and Luca Masotti and Alberto Fortini},
      title = {Sex Differences in Characteristics and Management of Patients with Acute Heart Failure},
      journal = {Cardiology and Cardiovascular Research},
      volume = {1},
      number = {3},
      pages = {84-90},
      doi = {10.11648/j.ccr.20170103.13},
      url = {https://doi.org/10.11648/j.ccr.20170103.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170103.13},
      abstract = {Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay and mortality was found between sexes. Hypertensive (26.8% vs 19.8%, p = 0.02) and valvular (13.6% vs 8.6%, p = 0.03) were the more prevalent etiologies of HF in females, while ischemic heart disease was in males (25.8% vs 18.2%, p = 0.01). HF with a preserved left ventricle ejection fraction (LVEF) was significantly more prevalent in females compared to males (51.3% vs 32.6%, p = 0.0001). Chronic obstructive pulmonary disease (COPD), peripheral artery diseases (PAD) and severe anemia were more frequent in males, while cognitive impairment was in females. Mean creatinine clearance at hospital admission was lower in females than in males (44.4 ± 22.2 vs 49.4 ± 26.3 ml/min, p < 0.05). Females received more frequently non invasive ventilation compared to males (15.1% vs 9.1%, p = 0.011). No difference between sexes was registered in the use of diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers and digoxin, whereas the use of anti-aldosterone agents, ivabradine and statins were more frequently used in males. No difference between sexes was found in the median number of drugs prescribed at hospital discharge [8 (interquartile range, IQR, 6-11) vs 9 (IQR 7-11)]. Eighty-two percent of females and seventy-nine percent of males were discharged at home (p = ns). Fifty-six percent of females compared with forty percent of males were dependent in activities of daily living at hospital discharge (p = 0.0001). The present study demonstrates that demographic characteristics, etiology, co-morbidity and echocardiographic pattern of HF differ according to sex. Further prospective study are warranted.},
     year = {2017}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Sex Differences in Characteristics and Management of Patients with Acute Heart Failure
    AU  - Paolo Biagi
    AU  - Valerio Verdiani
    AU  - Grazia Panigada
    AU  - Vieri Vannucchi
    AU  - Luca Masotti
    AU  - Alberto Fortini
    Y1  - 2017/07/24
    PY  - 2017
    N1  - https://doi.org/10.11648/j.ccr.20170103.13
    DO  - 10.11648/j.ccr.20170103.13
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 84
    EP  - 90
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20170103.13
    AB  - Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay and mortality was found between sexes. Hypertensive (26.8% vs 19.8%, p = 0.02) and valvular (13.6% vs 8.6%, p = 0.03) were the more prevalent etiologies of HF in females, while ischemic heart disease was in males (25.8% vs 18.2%, p = 0.01). HF with a preserved left ventricle ejection fraction (LVEF) was significantly more prevalent in females compared to males (51.3% vs 32.6%, p = 0.0001). Chronic obstructive pulmonary disease (COPD), peripheral artery diseases (PAD) and severe anemia were more frequent in males, while cognitive impairment was in females. Mean creatinine clearance at hospital admission was lower in females than in males (44.4 ± 22.2 vs 49.4 ± 26.3 ml/min, p < 0.05). Females received more frequently non invasive ventilation compared to males (15.1% vs 9.1%, p = 0.011). No difference between sexes was registered in the use of diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers and digoxin, whereas the use of anti-aldosterone agents, ivabradine and statins were more frequently used in males. No difference between sexes was found in the median number of drugs prescribed at hospital discharge [8 (interquartile range, IQR, 6-11) vs 9 (IQR 7-11)]. Eighty-two percent of females and seventy-nine percent of males were discharged at home (p = ns). Fifty-six percent of females compared with forty percent of males were dependent in activities of daily living at hospital discharge (p = 0.0001). The present study demonstrates that demographic characteristics, etiology, co-morbidity and echocardiographic pattern of HF differ according to sex. Further prospective study are warranted.
    VL  - 1
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Internal Medicine, Montepulciano Hospital, Siena, Italy

  • Department of Internal Medicine, Misericordia Hospital, Grosseto, Italy

  • Department of Internal Medicine, SS Damiano and Cosma Hospital, Pescia, Italy

  • Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy

  • Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy

  • Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy

  • Sections