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

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

3. Prevalence of heart failure by age and sex NHANES: 2005-2006Source: NCHS and NHLBI

4. Note: Hospital discharges include people discharged alive, dead and status unknown Hospital discharges for heart failure by sex United States: 1979-2006Source: NHDS/NCHS and NHLBI

5. 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

6. HFSIS – Heart Failure Survey in Israel 2003 25/25 Hospitals 93/98 Internal Medicine Departments 24/25 Cardiology Departments (24 ICCU, 16 Intermediate) 4872 Hospitalizations recorded 4514 Hospitalizations 4102 Patients Study Population

7. 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

9. HFSIS 2003 – Clinical Characteristics Men (n=2338) % 71.5 ± 12.4 43 71 48 30 38 46* 88* 40* Women (n=1764) % 75.9 ± 11.4* 59* 81* 53* 38* 54* 34 75 32 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

10. HFSIS 2003 – Functional Class and Type of HF Men (n=2338) % 36 38 46 57 14 61* 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

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

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

13. 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. 1.77 (1.32-2.37) 1.54 (1.14-2.07) 2.04 (1.46-2.86) 23.9% 25.5%** 1.19 (1.03-1.36) 1.00 (0.87-1.16) 1.00 (0.85-1.18)

14. 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

15. HFSIS 2003 – Variables Associated with 1-year Mortality Men 1.43 (1.30-1.58) 2.09 (1.70-2.58) 2.08 (1.63-2.69) 1.58 (1.28-1.95) 1.53 (1.24-1.91) 0.70 (0.56-0.88) 1.37 (1.08-1.72) 1.43 (1.07-1.97) 1.22 (0.99-1.51) 1.18 (0.95-1.46) 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 0 1 2 3 4 *OR (95% CI) Better outcomeWorse outcome *Other variables included in the model were : anemia (Hb <12) and primary HF

16. HFSIS 2003 – Variables Associated with 1-year Mortality Women 1.52 (1.36-1.71) 2.23 (1.65-3.01) 1.97 (1.56-2.49) 1.87 (1.49-2.35) 1.62 (1.17-2.22) 1.24 (0.98-1.56) 1.15 (0.92-1.41) Age (10-yr increm.) SBP <115 mmHg Renal failure (Cr>1.5mg%) NYHA III-IV Stroke Anemia (Hb<12gr%) Atrial fibrillation 0 1 2 3 4 *OR (95% CI) Better outcomeWorse outcome *Other variables included in the model were : HBP, COPD and diabetes.

17. 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

18. HFSIS 2003 – Crude (A) and Age-adjusted (B) Mortality A B P(LOG RANK) = 0.394 P(LOG RANK) = 0.079

19. 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

21. HFSIS 2003 – AF AF – Unknown AF – Chronic IntermittentAF - AllNo AF 1985626001,3602,742n 4.813.714.633.266.8%

22. 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%) NS524847 0.0001 4840Female (%) NS7677 0.0001 7772Age (yrs) NS757675 0.0001 7670 Male NS78 0.0001 7875 Female NS5863 0.0001 6243 >75 (%)

23. ♥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

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

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