אי ספיקת לב ופרפור פרוזדורים — מגדר

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: 2005 -2006 Source: NCHS and NHLBI

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

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

HFSIS 2003 – Age by Gender 4102 Patients Men Women 2339 Patients 1763 Patients 57% 43% 71. 5 ± 12. 4 yrs 73. 4 ± 12. 2 yrs 75. 9 ± 11. 4 yrs

HFSIS 2003 – Clinical Characteristics Men Women (n=2338) (n=1764) % % 71. 5 ± 12. 4 75. 9 ± 11. 4* 43 59* Hypertension 71 81* Diabetes 48 53* Atrial fib. 30 38* Anemia (Hb <12 gr%) 38 54* CRF (Cr >1. 5 mg/dl) 46* 34 IHD 88* 75 ACS 40* 32 Age, yrs (m ± SD) >75 years *P<0. 01

HFSIS 2003 – Functional Class and Type of HF Men Women (n=2338) (n=1764) % % NYHA Class III/IV 36 43* Ki. Ilip Class III/IV 38 48* Primary diagnosis HF 46 54* Acute decompensated HF 57 60* Diastolic HF 14 29* LVEF <40% 61* 39 *P<0. 01

HFSIS 2003 – Acute Management % * * *P<0. 001 *

HFSIS 2003 – Medications at Discharge % ** † * * * P<0. 0001; †P<0. 01 **P<0. 05

HFSIS 2003 – Mortality Men Women (n=2338) (n=1764) 3. 6% 6. 2%* In-hospital Mortality: Crude Unadjusted OR (95%CI) 1. 77 (1. 32 -2. 37) Age-adjusted OR 1. 54 (1. 14 -2. 07) Covariate adjusted OR† 2. 04 (1. 46 -2. 86) 1 -year Mortality: Crude 23. 9% 25. 5%** Unadjusted OR (95%CI) 1. 19 (1. 03 -1. 36) Age-adjusted OR 1. 00 (0. 87 -1. 16) Covariate adjusted OR† 1. 00 (0. 85 -1. 18) *P=0. 0001; **P=0. 02; OR women vs. men; †Adjusted for: age, DM, HBP, Renal failure (Cr>1. 5 mg%), anemia (Hb<12 gr%), NYHA III/IV, ACS, A. Fib, Sys. BP<115 mm. Hg, COPD, past stroke, primary HF.

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

HFSIS 2003 – Variables Associated with 1 -year Mortality Men *OR (95% CI) Age (10 -yr increm. ) 1. 43 (1. 30 -1. 58) NYHA III-IV 2. 09 (1. 70 -2. 58) SBP <115 mm. Hg 2. 08 (1. 63 -2. 69) Anemia (Hb<12 gr%) 1. 58 (1. 28 -1. 95) Renal failure (Cr>1. 5 mg%) 1. 53 (1. 24 -1. 91) Hypertension 0. 70 (0. 56 -0. 88) COPD 1. 37 (1. 08 -1. 72) Stroke 1. 43 (1. 07 -1. 97) Diabetes 1. 22 (0. 99 -1. 51) Atrial fibrillation 1. 18 (0. 95 -1. 46) 0 Better outcome 1 2 3 4 Worse outcome *Other variables included in the model were : anemia (Hb <12) and primary HF

HFSIS 2003 – Variables Associated with 1 -year Mortality Women *OR (95% CI) Age (10 -yr increm. ) 1. 52 (1. 36 -1. 71) SBP <115 mm. Hg 2. 23 (1. 65 -3. 01) Renal failure (Cr>1. 5 mg%) 1. 97 (1. 56 -2. 49) NYHA III-IV 1. 87 (1. 49 -2. 35) Stroke 1. 62 (1. 17 -2. 22) Anemia (Hb<12 gr%) 1. 24 (0. 98 -1. 56) Atrial fibrillation 1. 15 (0. 92 -1. 41) 0 Better outcome 1 2 3 4 Worse outcome *Other variables included in the model were : HBP, COPD and diabetes.

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

HFSIS 2003 – Crude (A) and Age-adjusted (B) Mortality B A P(LOG RANK) = 0. 394 P(LOG RANK) = 0. 079

HFSIS 2003 – Cox Age-adjusted Mortality by Gender and LVEF B A (M, EF<40% vs. M, EF≥ 40%) p=0. 02 (W, EF<40% vs. W, EF≥ 40%) p=0. 20 (M, EF>=40% vs. W, EF ≥ 40) p=0. 43 (M, EF<40% vs. W, EF<40%) p=0. 11

HFSIS 2003 – AF No AF AF - All Intermittent AF – Chronic AF – Unknown n 2, 742 1, 360 600 562 198 % 66. 8 33. 2 14. 6 13. 7 4. 8

HFSIS 2003 AF – Baseline Characteristics No – AF AF – All 2, 742 (67%) 1, 360 (33%) Female (%) 40 48 Age (yrs) 72 Male p p Intemittent Chronic Unknown 600 (15%) 562 (14%) 198 (5%) 0. 0001 47 48 52 NS 77 0. 0001 77 77 76 NS 70 76 0. 0001 75 76 75 NS Female 75 78 0. 0001 78 78 78 NS >75 (%) 43 62 0. 0001 63 63 58 NS

HFSIS 2003 – Conclusions ♥ 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.

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 – C 0 -Chairman