性别对东南亚多民族急性心力衰竭住院患者临床特征及院内结局的影响
Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure.
作者信息
Lam Carolyn S P, Chang Peter, Chia Shaw Yang, Sim Ling Ling, Gao Fei, Lee Fong Ling, Chai Ping, Wong Raymond Ching-Chiew, Seow Swee Chong, Leong Gerard Kui Toh, Yeo Poh Shuan Daniel, Sim David, Chua Terrance, Kwok Bernard W K
机构信息
National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore.
National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore.
出版信息
ASEAN Heart J. 2014;22(1):8. doi: 10.7603/s40602-014-0008-y.
OBJECTIVES
To study sex differences in clinical characteristics and outcomes among multi-ethnic Southeast Asian patients with hospitalized heart failure (HHF).
BACKGROUND
HHF is an important public health problem affecting man and women globally. Reports from Western populations suggest striking sex differences in risk factors and outcomes in HHF. However, this has not been studied in a multi-ethnic Asian population.
METHODS
Using the population-based resources of the Singapore Cardiac Data Bank, we studied 5,703 consecutive cases of HHF admitted across hospitals in the Southeast Asian nation of Singapore from 1st January, 2008 through 31st December, 2009.
RESULTS
Women accounted for 46% of total admissions and were characterized by older age (73 vs. 67 years; p<0.001), higher prevalence of hypertension (78.6 vs. 72.1%; p<0.001) or atrial fibrillation (22.2 vs. 18.1%; p<0.001), and lower prevalence of coronary artery disease (33.8 vs. 41.0%; p<0.001) or prior myocardial infarction (14.9 vs. 19.8%; p<0.001). Women were more likely than men to have HHF with preserved ejection fraction (42.5% versus 20.8%, p < 0.001). Women were less likely than men to receive evidencebased therapies at discharge, both in the overall group and in the sub-group with reduced ejection fraction. Women had longer lengths of stay (5.6 vs. 5.1 days; p<0.001) but similar in-hospital mortality and one-year rehospitalization rates compared to men. Independent predictors of mortality or rehospitalization in both men and women included prior myocardial infarction and reduced ejection fraction. Among women alone, additional independent predictors were renal impairment, atrial fibrillation, and diabetes. Prescription of beta-blockers and ACE-inhibitors at discharge was associated with better outcomes.
CONCLUSION
Among multi-ethnic Asian patients with HHF, there are important sex differences in clinical characteristics and prognostic factors. These data may inform sex-specific strategies to improve outcomes of HHF in Southeast Asians.
目的
研究多民族东南亚住院心力衰竭（HHF）患者的临床特征和预后的性别差异。
背景
HHF是一个影响全球男性和女性的重要公共卫生问题。西方人群的报告显示，HHF的危险因素和预后存在显著的性别差异。然而，这在多民族亚洲人群中尚未得到研究。
方法
利用新加坡心脏数据库的基于人群的资源，我们研究了2008年1月1日至2009年12月31日期间在东南亚国家新加坡各医院连续收治的5703例HHF病例。
结果
女性占总入院人数的46%，其特点是年龄较大（73岁对67岁；p<0.001），高血压患病率较高（78.6%对72.1%；p<0.001）或心房颤动患病率较高（22.2%对18.1%；p<0.001），而冠状动脉疾病患病率较低（33.8%对41.0%；p<0.001）或既往心肌梗死患病率较低（14.9%对19.8%；p<0.001）。女性比男性更有可能患射血分数保留的HHF（42.5%对20.8%，p<0.001）。在总体组和射血分数降低的亚组中，女性出院时接受循证治疗的可能性均低于男性。女性住院时间更长（5.6天对5.1天；p<0.001），但与男性相比，住院死亡率和一年再住院率相似。男性和女性死亡或再住院的独立预测因素包括既往心肌梗死和射血分数降低。仅在女性中，其他独立预测因素是肾功能损害、心房颤动和糖尿病。出院时使用β受体阻滞剂和ACE抑制剂与更好的预后相关。
结论
在多民族亚洲HHF患者中，临床特征和预后因素存在重要的性别差异。这些数据可为改善东南亚HHF患者预后的针对性别策略提供参考。
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