Bielecka-Dabrowa Agata, Trzmielak Dariusz, Sakowicz Agata, Janikowski Kamil, Banach Maciej
Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland.
Arch Med Sci. 2024 Dec 31;20(6):1797-1808. doi: 10.5114/aoms/183523. eCollection 2024.
The aim of this study was to implement a model of healthcare for patients with heart failure (HF) and to assess the differences between men and women in the study population.
Through care and an extensive educational panel (dietary recommendations, physical activity, titration of diuretics, psychological support), emphasis was placed on prevention. All patients had a baseline cardiology consultation with recommendations regarding treatment, self-care, diet, and exercise. Based on regular measurements of weight and blood pressure HF patients were telemonitored by nurses, primary care physicians and referred to cardiologists when necessary. The questionnaire was conducted in all patients at baseline after enrollment to the study and after 3 months of telemonitoring and extensive educational process.
The study finally included 140 men with an average age of 66 years (SD: 56-71) and 163 women with an average age of 64 years (58-72). The ischemic origin of HF was present in 78% of men and 73% of women ( = 0.40), and 31% of men and 16% of women declared myocardial infarction in the past ( = 0.002). Men more often survived sudden cardiac arrest (7.8% vs. 1.2%; = 0.004) and had implantable cardiac devices compared to women (16% vs. 3%; = 0.001). Male patients reported significantly more often alcohol consumption, smoking, and less frequently any physical activity. Women significantly more often than men suffered from cancer, depression, and thromboembolic events and less frequently from obstructive sleep apnea. The mean left ventricular ejection fraction (LVEF) was 43% (SD: 30-58) for men, and 57% (45-63) for women ( = 0.0001), and women suffered mainly from heart failure with preserved ejection fraction. There were no differences between genders regarding the number of hospitalizations in last 12 months. The men, despite lower LVEF, felt short of breath/tired when climbing the stairs up than women (3 [2-4] vs. 2 floors [1-3]; = 0.001), had higher distance in meters when walking on flat ground (400 [200-400] vs. 300 m [100-400]; = 0.0001), and less frequently had to get up to go to the toilet at night ( = 0.03). Men also suffered significantly less often from shortness of breath at rest, swelling of the lower limbs and shortness of breath that wakes them up at night. Only 35% of men and 19% of women had HF self-care training, and only 35% of men and 46% of women knew how to increase the dose of diuretic on their own if shortness of breath or swelling increases. Based on the EuroQol-5 dimensions 5-levels questionnaire, significantly more women than men reported moderate and serious problems with moving around, serious problems with performing ordinary activities independently as well as moderate and serious pain problem and a significant level of anxiety. Men more often than women reported serious problems with self-care.
Women suffer more often from HF symptoms and have worse quality of life assessed in EQ-5D-5L than men despite their higher LVEF.
本研究的目的是实施一种针对心力衰竭（HF）患者的医疗模式，并评估研究人群中男性和女性之间的差异。
通过护理和广泛的教育小组（饮食建议、体育活动、利尿剂滴定、心理支持），重点在于预防。所有患者均接受了基线心脏病咨询，内容涉及治疗、自我护理、饮食和运动建议。基于对体重和血压的定期测量，护士对HF患者进行远程监测，初级保健医生在必要时将患者转诊给心脏病专家。在研究入组后的基线以及远程监测和广泛教育过程3个月后，对所有患者进行问卷调查。
该研究最终纳入了140名平均年龄为66岁（标准差：56 - 71岁）的男性和163名平均年龄为64岁（58 - 72岁）的女性。HF的缺血性起源在78%的男性和73%的女性中存在（P = 0.40），31%的男性和16%的女性宣称过去曾发生心肌梗死（P = 0.002）。与女性相比，男性心脏骤停后存活的比例更高（7.8%对1.2%；P = 0.004），且植入心脏设备的比例更高（16%对3%；P = 0.001）。男性患者报告饮酒、吸烟的频率显著更高，而进行任何体育活动的频率更低。女性患癌症、抑郁症和血栓栓塞事件的比例显著高于男性，患阻塞性睡眠呼吸暂停的比例则低于男性。男性的平均左心室射血分数（LVEF）为43%（标准差：30 - 58），女性为57%（45 - 63）（P = 0.0001），且女性主要患有射血分数保留的心力衰竭。在过去12个月的住院次数方面，性别之间没有差异。尽管男性的LVEF较低，但他们爬楼梯时比女性更易感到气短/疲惫（3层[2 - 4层]对2层[1 - 层]；P = 0.001），在平地上行走的距离更远（400米[200 - 400米]对300米[100 - 400米]；P = 0.0001），且夜间起床去厕所的频率更低（P = 0.03）。男性在静息时气短、下肢肿胀以及夜间因气短醒来的情况也显著较少。只有35%的男性和19%的女性接受过HF自我护理培训，只有35%的男性和46%的女性知道在气短或肿胀加重时如何自行增加利尿剂剂量。根据欧洲五维健康量表（EuroQol - 5 dimensions 5 - levels questionnaire），报告在行动、独立进行日常活动、中度和重度疼痛问题以及显著焦虑水平方面存在中度和重度问题的女性显著多于男性。男性报告自我护理方面存在严重问题的频率高于女性。
尽管女性的LVEF较高，但与男性相比，她们更常出现HF症状，且在EQ - 5D - 5L评估中生活质量更差。
