MUNICH – Gender differences in comorbidities affected the medications prescribed to men and women hospitalized with acute heart failure, although their in-hospital mortality rate remained similar, according to a retrospective analysis of nearly 5,000 hospital charts.
The study showed that men who were hospitalized with acute heart failure (AHF) were more likely to receive beta-blockers and aspirin than were women. Meanwhile, women were more likely to be obese, have diabetes, or have atrial fibrillation.
"Perhaps there are differences in the pathophysiology of AHF between women and men, which should be taken into account in order to achieve gender-tailored management," said Dr. John Parissis, who presented the study at the annual congress of the European Society of Cardiology.
The study was a subanalysis of the Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF), a chart audit survey of 4,953 patients hospitalized for AHF in 666 hospitals in nine countries (France, Germany, Spain, Italy, Greece, United Kingdom, Turkey, Australia, and Mexico.)
Women made up 37% of the patients, consistent with ratios in other registries, said Dr. Parissis of Attikon University Hospital, Greece. They presented with AHF at an older age and had higher rates of de novo heart failure. They were also half as likely as were men to present with cardiogenic shock, but more than twice as likely to have right heart failure.
The study showed that women hospitalized with AHF had a higher prevalence of diabetes (47% v. 43%), obesity (30% v. 25%), anemia (17% v. 13%), atrial fibrillation or flutter (49% v. 42%), dementia (6% v. 3%), and depression (11% v. 7%), compared with men.
Meanwhile, men had a higher prevalence of chronic obstructive pulmonary disease (COPD) and asthma (27% v. 21%), and coronary artery disease (CAD) (35% v. 24%) compared with women.
Upon admission, women were less likely than were men to receive aspirin, clopidogrel, and beta-blockers, because of their comorbidities and lower rates of CAD. But compared with men, they were more likely to be on angiotensin receptors blockers and digitalis treatment, because of higher incidence of atrial fibrillation, according to the investigators.
There were no significant differences in use of ACE inhibitors, diuretics, and nitrates between genders, the analysis showed.
Both genders received continuous positive airway pressure (CPAP) and mechanical ventilation. Fewer women, however, were supported by intra-aortic balloon pump (IABP), underwent percutaneous coronary intervention, or had coronary artery bypass graft surgery.
In addition, in-hospital mortality was similar between genders (10.5% for men vs 11.1% for women). "The presence of higher ejection fraction and less CAD in women may positively affect survival in women," said Dr. Parissis.
But, "the existence of other serious comorbidities and underprescription of life saving medications such as beta-blockers may counteract this positive effect on their in-hospital survival," he added. "This point may explain the similar mortality rate between genders."
At discharge, the proportion of patients treated with medications increased. Nevertheless, the differences between genders remained significant, the authors wrote.
The differences in treatment call for "a more intensive implementation of heart failure guidelines to optimize life saving medications, especially in women," said Dr. Parissis.
Dr. Parissis is a member of the ALARM-HF Steering Committee and presented the study on the committee’s behalf. He said he had received research grants from Abbott and Orion Pharma.