Abstract
Background
Controversy exists concerning the influence of gender in the prognosis of patients with heart failure and no evidence is available from specific heart failure clinics.
Hypothesis
Women with ambulatory heart failure are managed differently than men, although their prognosis might be better than men.
Methods and Results
We analyzed the clinical characteristics, complementary test results, treatment, and prognosis in 4720 patients with chronic heart failure seen in 62 specialized clinics forming part of a multicenter registry during a mean follow‐up of 40 months. The mean age was 65 ± 12 years and 71% were men. The men were younger than the women and more often had a history of hyperlipidemia and ischemic heart disease. The men had a more advanced heart failure New York Heart Association (NYHA) functional class (III‐IV) than the women and a greater frequency of systolic ventricular dysfunction. The men more often received treatment with β‐blockers, vasodilators, and antiplatelet aggregators as well as higher mean doses as compared with the women. The overall survival after the follow‐up was similar for both genders, although the women had lower rates of survival free of admission for heart failure.
Conclusions
Despite the mortality of women and men with heart failure being similar, the rate of readmission for heart failure is greater in women in specialized heart failure clinics. These results may be associated with the pharmacological treatment differences observed. Copyright © 2010 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (340.6 KB).
References
- 1. Stewart S, MacIntyre K, Capewell S, McMurray JJ Heart failure and the aging population: an increasing burden in the 21st century? Heart 2003; 89(1): 49–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Koelling TM, Chen RS, Lubwama RN, L'Italien GJ, Eagle KA The expanding national burden of heart failure in the United States: the influence of heart failure in women. Am Heart J 2004; 147(1): 74–78. [DOI] [PubMed] [Google Scholar]
- 3. Rodriguez‐Artalejo F, Banegas Banegas JR, Guallar‐Castillon P Epidemiology of heart failure. Rev Esp Cardiol 2004; 57(2): 163–170. [PubMed] [Google Scholar]
- 4. Piñ a IL A better survival for women with heart failure? It's not so simple. J Am Coll Cardiol 2003; 42(12): 2135–2138. [DOI] [PubMed] [Google Scholar]
- 5. Opasich C, Tavazzi L, Lucci D, et al. Comparision of one‐year outcome in women versus men with chronic congestive heart failure. Am J Cardiol 2000; 86: 353–357. [DOI] [PubMed] [Google Scholar]
- 6. Varela Roman A, Grigorian Shamagian L, Bandin Dieguez M, Rigueiro Veloso P, Gonzá lez Juanetey J Influence of sex on mortality in hospitalized patients with congestive heart failure and preserved or depressed systolic function. Rev Esp Cardiol 2005; 58: 1171–1180. [PubMed] [Google Scholar]
- 7. McCullough PA, Philbin EF, Spertus JA, et al. Opportunities for improvement in the diagnosis and treatment of heart failure. Clin Cardiol 2003; 26(5): 231–237. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Ng AC, Wong HS, Yong AS, Sindone AP Impact of gender on outcomes in chronic heart failure. Int J Cardiol 2006; 117(2): 214–221. [DOI] [PubMed] [Google Scholar]
- 9.Guidelines for the diagnosis and treatment of chronic heart failure. The Task Force for the diagnosis and treatment of chronic heart failure. European Society of Cardiology. Eur Heart J 2001; 22: 1527–1560. [DOI] [PubMed] [Google Scholar]
- 10. Opasich C, De Feo S, Ambrosio GA, et al. The real woman with heart failure. Impact of sex on current in hospital management of heart failure by cardiologist and internists. Eur J Heart Fail 2004; 6: 769–779. [DOI] [PubMed] [Google Scholar]
- 11. O'Meara E, Clayton T, McEntegart MB, et al. Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure. Circulation 2007; 115: 3111–3120. [DOI] [PubMed] [Google Scholar]
- 12. Shekelle PG, Rich MW, Morton SC, et al. Efficacy of angiotensin‐converting enzyme inhibitors and β‐blockers in the management of left ventricular systolic disfunction according to race, gender, and diabetic status. A meta‐analysis of major clinical trials. J Am Coll Cardiol 2003; 41: 1529–1538. [DOI] [PubMed] [Google Scholar]
- 13. Shah MR, Granger CB, Bart BA, et al. Sex‐related differences in the use and adverse effects of angiotensin‐converting enzyme inhibitors in heart failure: the study of patient intolerance of converting enzyme inhibitors registry. Am J Med 2000; 109: 489–492. [DOI] [PubMed] [Google Scholar]
- 14. Atienza F, Anguita M, Martinez‐Alzamora N, et al; PRICE Study Group. Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail 2004; 6(5): 643–652. [DOI] [PubMed] [Google Scholar]
- 15. Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation 2003; 108: 184–191. [DOI] [PubMed] [Google Scholar]