אי ספיקת לב ופרפור פרוזדורים - מגדר ד"ר א. שוטן מכון הלב הילל יפה, חדרה

Heart Disease and Stroke Statistics — 2009 Update Donald Lloyd-Jones

Prevalence of heart failure by age and sex NHANES: Source: NCHS and NHLBI

Note: Hospital discharges include people discharged alive, dead and status unknown Hospital discharges for heart failure by sex United States: Source: NHDS/NCHS and NHLBI

Gender Differences in the Management and Outcome of Patients Hospitalized with Heart Failure in HFSIS 2003 E. Cohen, M. Garty, A. Shotan, BS. Lewis, C. Rachima-Maoz, A. Porath, A. Sandach, M. Moriel, S. Behar, A. Caspi, and S. Gottlieb For the Steering Committee and Investigators of HFSIS 2003

HFSIS – Heart Failure Survey in Israel /25 Hospitals 93/98 Internal Medicine Departments 24/25 Cardiology Departments (24 ICCU, 16 Intermediate) 4872 Hospitalizations recorded 4514 Hospitalizations 4102 Patients Study Population

4102 Patients Men 2339 Patients 57% Women 1763 Patients 43% 71.5 ± 12.4 yrs 73.4 ± 12.2 yrs 75.9 ± 11.4 yrs HFSIS 2003 – Age by Gender

HFSIS 2003 – Clinical Characteristics Men (n=2338) % 71.5 ± * 88* 40* Women (n=1764) % 75.9 ± 11.4* 59* 81* 53* 38* 54* Age, yrs (m ± SD) >75 years Hypertension Diabetes Atrial fib. Anemia (Hb <12 gr%) CRF (Cr >1.5 mg/dl) IHD ACS *P<0.01

HFSIS 2003 – Functional Class and Type of HF Men (n=2338) % * Women (n=1764) % 43* 48* 54* 60* 29* 39 NYHA Class III/IV KiIlip Class III/IV Primary diagnosis HF Acute decompensated HF Diastolic HF LVEF <40% *P<0.01

HFSIS 2003 – HFSIS 2003 – Acute Management % * * *P<0.001 *

Medications at Discharge HFSIS 2003 – Medications at Discharge % * P<0.0001; †P<0.01 **P<0.05 * * * † * * † **

HFSIS 2003 – Mortality Men (n=2338) 3.6% Women (n=1764) 6.2%* In-hospital Mortality: Crude Unadjusted OR (95%CI) Age-adjusted OR Covariate adjusted OR † 1-year Mortality: Crude Unadjusted OR (95%CI) Age-adjusted OR Covariate adjusted OR † *P=0.0001; **P=0.02; OR women vs. men; †Adjusted for: age, DM, HBP, Renal failure (Cr>1.5mg%), anemia (Hb<12gr%), NYHA III/IV, ACS, A. Fib, Sys. BP<115 mmHg, COPD, past stroke, primary HF ( ) 1.54 ( ) 2.04 ( ) 23.9% 25.5%** 1.19 ( ) 1.00 ( ) 1.00 ( )

Men 1.SBP <115 mmHg 2.Renal failure 3.Age 4.NYHA III-IV 5.Primary HF Women 1.SBP <115 mmHg 2.NYHA III-IV 3.Renal failure 4.Stroke 5.Hypertension (better) 6.Age 7.Atrial Fib. 8.ACS Variables Associated with In-hospital Mortality HFSIS 2003 – Variables Associated with In-hospital Mortality

HFSIS 2003 – Variables Associated with 1-year Mortality Men 1.43 ( ) 2.09 ( ) 2.08 ( ) 1.58 ( ) 1.53 ( ) 0.70 ( ) 1.37 ( ) 1.43 ( ) 1.22 ( ) 1.18 ( ) Age (10-yr increm.) NYHA III-IV SBP <115 mmHg Anemia (Hb<12 gr%) Renal failure (Cr>1.5mg%) Hypertension COPD Stroke Diabetes Atrial fibrillation *OR (95% CI) Better outcomeWorse outcome *Other variables included in the model were : anemia (Hb <12) and primary HF

HFSIS 2003 – Variables Associated with 1-year Mortality Women 1.52 ( ) 2.23 ( ) 1.97 ( ) 1.87 ( ) 1.62 ( ) 1.24 ( ) 1.15 ( ) Age (10-yr increm.) SBP <115 mmHg Renal failure (Cr>1.5mg%) NYHA III-IV Stroke Anemia (Hb<12gr%) Atrial fibrillation *OR (95% CI) Better outcomeWorse outcome *Other variables included in the model were : HBP, COPD and diabetes.

Men 1.Age 2.NYHA III-IV 3.SBP <115 mmHg 4.Anemia 5.Renal failure 6.Hypertension (better) 7.COPD 8.Stroke 9.Diabetes Women 1.Age 2.Renal failure 3.NYHA III-IV 4.SBP <115 mmHg 5.Stroke 6.Anemia Variables Associated with 1-Year Mortality HFSIS 2003 – Variables Associated with 1-Year Mortality

HFSIS 2003 – Crude (A) and Age-adjusted (B) Mortality A B P(LOG RANK) = P(LOG RANK) = 0.079

HFSIS 2003 – Cox Age-adjusted Mortality by Gender and LVEF A B (M,EF<40% vs. M,EF≥40%) p=0.02 (M,EF>=40% vs. W,EF ≥ 40) p=0.43 (W,EF<40% vs. W,EF≥40%) p=0.20 (M,EF<40% vs. W,EF<40%) p=0.11

HFSIS 2003 – AF AF – Unknown AF – Chronic IntermittentAF - AllNo AF ,3602,742n %

HFSIS 2003 AF – Baseline Characteristics p Unknown 198 (5%) Chronic 562 (14%) Intemittent 600 (15%) p AF – All 1,360 (33%) No – AF 2,742 (67%) NS Female (%) NS Age (yrs) NS Male NS Female NS >75 (%)

♥In HFSIS 2003 national survey of hospitalized HF patients, women were older than men and had more comorbidities. ♥Women had worse presentation than men despite a better LVEF. ♥Use of ACE-I/ARB, spironolactone, and digitalis was similar in women and men. However, women received less often  -blockers, aspirin and statins, but more diuretics and CCB.. ♥In-hospital crude mortality was 2-fold higher in women than in men, a difference that disappeared at 1-year. ♥Gender disparities in outcome most probably relate to women’s older age, differences in HF etiology and presentation. HFSIS 2003 – Conclusions

רפואה מגדרית ומחלות לב - עתיד ♥טיפול תרופתי – בחירת תרופה, מינון, תופעות לוואי ♥הזדקנות ♥מחלות לב בחולים אונקולוגיים – ♥לדוג': סרטן השד, סרטן הערמונית

Uri Elkayam, MD – Chairman Avraham Shotan, MD – C0-Chairman