性别特异性差异导致德国心力衰竭住院患者的时间趋势和结局不同。
Sex-specific differences drive temporal trends and outcomes of patients hospitalized for heart failure in Germany.
机构信息
Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
出版信息
Prog Cardiovasc Dis. 2020 Sep-Oct;63(5):591-598. doi: 10.1016/j.pcad.2020.03.013. Epub 2020 Mar 26.
BACKGROUND
Despite remarkable improvements in treatment of cardiovascular disease, heart failure (HF) is still characterized by high mortality rate. Sex-specific differences in HF have been described, but underlying reasons are widely unexplored.
METHODS
The nationwide German inpatient sample (2005-2016) was used for this sex-specific analyses. Temporal trends on hospitalizations, mortality, and treatments were analysed and independent predictors of adverse outcomes identified.
RESULTS
The analysis comprises 4,538,977 hospitalizations due to HF (52.0%women) in Germany (2005-2016). Although women were older (median 82(IQR75-87) vs.76(69-82),P < 0.001), coronary artery disease (CAD, 50.3% vs. 30.7%,P < 0.001) was more prevalent in men, who were more often treated with percutaneous intervention (PCI;3.4% vs. 1.4%,P < 0.001) and implantable cardioverter-defibrillator (2.2% vs. 0.5%,P < 0.001). In-hospital mortality was significantly lower in men than in women (8.9% vs.10.2%,P = 0.001) and was reduced in patients who received PCI or implantation of an implantable cardioverter-defibrillator. While total numbers of hospitalizations between 2005 and 2016 increased in both men (β-estimate 7185.71 (95%CI 6502.23 to 7869.18),P < 0.001) and women (β-estimate 5297.60 (95%CI 4557.37 to 6037.83),P < 0.001) as well as almost all comorbid co-conditions, in-hospital mortality rate decreased more distinctly in women (β-estimate -0.41 (95%CI -0.42 to -0.39),P < 0.001) compared to men (β-estimate -0.29 (95%CI -0.30 to -0.27),P < 0.001).
CONCLUSIONS
Interventional treatments of HF were associated with improved outcomes and equally beneficial for both sexes. However, they were more often used in male HF patients, in which CAD is significantly more frequent than in female HF patients. This may explain the higher case fatality rate of HF in females.
背景
尽管心血管疾病的治疗取得了显著进展，但心力衰竭（HF）仍然具有高死亡率的特点。已经描述了 HF 中的性别差异，但根本原因尚未得到广泛探索。
方法
本研究使用了全国性的德国住院患者样本（2005-2016 年）进行了这种性别特异性分析。分析了住院、死亡率和治疗方面的时间趋势，并确定了不良预后的独立预测因素。
结果
该分析包括德国 2005-2016 年因 HF 住院的 4538977 例患者（52.0%为女性）。尽管女性年龄更大（中位数 82（IQR75-87）比 76（69-82），P < 0.001），但男性中更常见冠心病（CAD，50.3%比 30.7%，P < 0.001），更常接受经皮介入治疗（PCI；3.4%比 1.4%，P < 0.001）和植入式心脏复律除颤器（2.2%比 0.5%，P < 0.001）。男性院内死亡率明显低于女性（8.9%比 10.2%，P = 0.001），接受 PCI 或植入植入式心脏复律除颤器的患者死亡率降低。尽管 2005 年至 2016 年间男性（β估计值 7185.71（95%CI 6502.23 至 7869.18），P < 0.001）和女性（β估计值 5297.60（95%CI 4557.37 至 6037.83），P < 0.001）的住院总数均增加，并且几乎所有合并的共存疾病均有所增加，但女性的院内死亡率下降更为明显（β估计值 -0.41（95%CI -0.42 至 -0.39），P < 0.001），而男性的死亡率下降幅度较小（β估计值 -0.29（95%CI -0.30 至 -0.27），P < 0.001）。
结论
HF 的介入治疗与改善预后相关，对两性均有益。但是，它们在男性 HF 患者中更常用，而 CAD 在男性 HF 患者中比女性 HF 患者更常见。这可能解释了女性 HF 患者的病死率较高的原因。
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