University Medical Center Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2013 Dec;15(12):1374-81. doi: 10.1093/eurjhf/hft115.
Differences in manifestation, treatment, and outcomes of acute heart failure between men and women have not been well studied. The objective of this analysis was to characterize differences in clinical presentation, and in-hospital and post-discharge outcomes between sexes in acute heart failure patients.
Clinical profiles, treatment characteristics, and outcomes were compared between sexes in 2033 patients hospitalized for acute heart failure and impaired renal function. Women comprised 33% of the study population and were older, had higher body mass index, LVEF, and systolic blood pressure, and a greater prevalence of diabetes. At baseline, women showed signs and symptoms of congestion comparable with men, but more often had rales, orthopnoea, and worse renal function. Women were less intensively diuresed, as indicated by lower oral and intravenous diuretic doses used, fewer dose increases, and less total weight loss during hospitalization. Furthermore, hospitalization was slightly but significantly prolonged in women (11.04 ± 7.8 vs. 10.65 ± 8.86 days; P = 0.024). Age-adjusted 180-day mortality was lower in women (15.8% vs. 18.5%, hazard ratio 0.74; 95% confidence interval 0.59-0.93, P = 0.010), but multivariable risk-adjusted mortality was similar in both sexes, mainly attributable to lower blood urea nitrogen, higher LVEF, and higher systolic blood pressure in women compared with men.
Women with acute heart failure present with a clinical profile different from that of men, with more hypertension, diabetes, and depression, and a preserved LVEF. During hospitalization, they were less intensively diuresed. Nevertheless, risk-adjusted 180-day outcome was similar between sexes.
男性和女性急性心力衰竭的表现、治疗和结局存在差异，但这些差异尚未得到充分研究。本分析旨在描述急性心力衰竭伴肾功能不全患者的临床特征、住院和出院后结局的性别差异。
在 2033 例因急性心力衰竭和肾功能受损住院的患者中，比较了性别间的临床特征、治疗特征和结局。女性占研究人群的 33%，年龄较大，体重指数、左心室射血分数和收缩压较高，糖尿病患病率较高。基线时，女性的充血体征和症状与男性相当，但啰音、端坐呼吸和肾功能更差。女性的利尿治疗强度较低，表现为口服和静脉利尿剂剂量较低、剂量增加较少，以及住院期间总体重减轻较少。此外，女性的住院时间略有但显著延长（11.04±7.8 天 vs. 10.65±8.86 天；P=0.024）。校正年龄后，女性 180 天死亡率较低（15.8% vs. 18.5%，风险比 0.74；95%置信区间 0.59-0.93，P=0.010），但多变量风险调整后死亡率在两性间相似，这主要归因于女性的血尿素氮较低、左心室射血分数较高和收缩压较高。
与男性相比，患有急性心力衰竭的女性表现出不同的临床特征，高血压、糖尿病和抑郁症更为常见，左心室射血分数保持正常。在住院期间，她们的利尿治疗强度较低。然而，两性间 180 天的风险调整后结局相似。
