Grupper Avishay, Freimark Dov, Murad Havi, Olmer Liraz, Benderly Michal, Ziv Arnona, Friedman Nurit, Kaufman Galit, Silber Haim, Kalter-Leibovici Ofra
Leviev Heart Center, Ramat Gan, Israel.
Sheba Medical Center, Ramat Gan, Israel.
Front Cardiovasc Med. 2022 Nov 1;9:1012361. doi: 10.3389/fcvm.2022.1012361. eCollection 2022.
This is a sub-analysis of a randomized controlled trial on heart failure (HF) disease management (DM) in which patients with HF ( = 1,360; 27.5% women) were assigned randomly to DM ( = 682) or usual care (UC) ( = 678). Study intervention did not significantly affect the rate of hospital admissions or mortality. This study evaluates sex-related differences in baseline characteristics, clinical manifestations, adherence to treatment and outcomes among the study cohort.
Association between sex and hospital admissions and mortality was tested in multivariable models adjusted for the patients' baseline characteristics. The primary composite outcome of the study included time to first HF hospitalization or all-cause mortality. Secondary composite outcome included number of hospital admissions and days of hospitalization, for HF and all other causes.
Compared to males, females recruited in the study were on average 3 years older [median age 72 (62, 78) vs. 75 (65, 82), = 0.001], with higher prevalence of preserved left ventricular function (LVEF ≥50%) and lower frequency of ischemic heart disease (IHD) ( ≤ 0.001). Females had shorter 6-min walking distance and worse quality of life and depression scores at baseline ( < 0.001). The proportion of patients receiving HF recommended medical treatment was similar among females and males. During a median follow-up of 2.7 years (range: 0-5), there were no significant differences between females and males with respect to the time elapsed until the study primary endpoint and its components in univariate analysis [557 (56.5%) males and 218 (58.3%) females were hospitalized for HF or died for any cause; > 0.05]. Multivariable analysis showed that females were significantly less likely than males to experience the primary outcome [adjusted hazard ratio (HR) = 0.835, 95% CI: 0.699, 0.998] or to die from any cause [adjusted HR = 0.712; 95%CI: 0.560, 0.901]. The sex-related mortality differences were especially significant among patients with non-preserved EF, with IHD or with recent HF hospitalization. Females also had lower rates of all-cause hospital admissions [adjusted rate ratio = 0.798; 95%CI: 0.705, 0.904] and were more likely to adhere to HF medical therapy compared to males.
Females with HF fare better than men. Sex related differences were not explained by baseline and morbidity-related characteristics or adherence to medical treatment.
这是一项关于心力衰竭（HF）疾病管理（DM）的随机对照试验的亚分析，其中HF患者（n = 1360；27.5%为女性）被随机分配至DM组（n = 682）或常规护理（UC）组（n = 678）。研究干预未显著影响住院率或死亡率。本研究评估了研究队列中基线特征、临床表现、治疗依从性和结局方面的性别差异。
在根据患者基线特征进行调整的多变量模型中检验性别与住院率和死亡率之间的关联。研究的主要复合结局包括首次HF住院时间或全因死亡率。次要复合结局包括HF及所有其他原因导致的住院次数和住院天数。
与男性相比，本研究纳入的女性平均年龄大3岁[年龄中位数72（62，78）岁 vs. 75（65，82）岁，P = 0.001]，左心室功能保留（LVEF≥50%）的患病率更高，缺血性心脏病（IHD）的发生率更低（P≤0.001）。女性在基线时6分钟步行距离更短，生活质量和抑郁评分更差（P<0.001）。接受HF推荐药物治疗的患者比例在女性和男性中相似。在中位随访2.7年（范围：0 - 5年）期间，在单变量分析中，女性和男性在直至研究主要终点及其组成部分的时间方面无显著差异[557名（56.5%）男性和218名（58.3%）女性因HF住院或因任何原因死亡；P>0.05]。多变量分析显示，女性发生主要结局的可能性显著低于男性[调整后风险比（HR）= 0.835，95%置信区间（CI）：0.699，0.998]或因任何原因死亡的可能性显著低于男性[调整后HR = 0.712；95%CI：0.560，0.901]。在EF未保留、患有IHD或近期有HF住院的患者中，性别相关的死亡率差异尤为显著。女性的全因住院率也更低[调整后率比 = 0.798；95%CI：0.705，0.904]，并且与男性相比更有可能坚持HF药物治疗。
患有HF的女性比男性预后更好。性别相关差异无法通过基线和发病率相关特征或药物治疗依从性来解释。
