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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

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אי ספיקת לב ופרפור פרוזדורים - מגדר

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  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 sexNHANES: 2005-2006 Source: NCHS and NHLBI

  4. 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

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

  6. HFSIS 2003 – Age by Gender 4102 Patients Women 1763 Patients 43% Men 2339 Patients 57% 71.5 ± 12.4yrs73.4 ± 12.2yrs75.9 ± 11.4yrs

  7. HFSIS 2003 – Clinical Characteristics Age, yrs (m ± SD) >75 years Hypertension Diabetes Atrial fib. Anemia (Hb <12 gr%) CRF (Cr >1.5 mg/dl) IHD ACS 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 *P<0.01

  8. HFSIS 2003 – Functional Class and Type of HF NYHA Class III/IV KiIlip Class III/IV Primary diagnosis HF Acute decompensated HF Diastolic HF LVEF <40% Men (n=2338) % 36 38 46 57 14 61* Women (n=1764) % 43* 48* 54* 60* 29* 39 *P<0.01

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

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

  11. HFSIS 2003 – Mortality 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† Men (n=2338) 3.6% Women (n=1764) 6.2%* 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) *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.

  12. HFSIS 2003 – Variables Associated with In-hospital Mortality • Women • SBP <115mmHg • NYHA III-IV • Renal failure • Stroke • Hypertension (better) • Age • Atrial Fib. • ACS • Men • SBP <115mmHg • Renal failure • Age • NYHA III-IV • Primary HF

  13. 0 1 2 3 4 HFSIS 2003 – Variables Associated with 1-year MortalityMen Age (10-yr increm.) NYHA III-IV SBP <115mmHg Anemia (Hb<12 gr%) Renal failure (Cr>1.5mg%) Hypertension COPD Stroke Diabetes Atrial fibrillation *OR (95% CI) 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) Better outcome Worse outcome *Other variables included in the model were : anemia (Hb <12) and primary HF

  14. 0 1 2 3 4 HFSIS 2003 – Variables Associated with 1-year MortalityWomen Age (10-yr increm.) SBP <115mmHg Renal failure (Cr>1.5mg%) NYHA III-IV Stroke Anemia (Hb<12gr%) Atrial fibrillation *OR (95% CI) 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) Better outcome Worse outcome *Other variables included in the model were : HBP, COPD and diabetes.

  15. HFSIS 2003 – Variables Associated with 1-Year Mortality • Women • Age • Renal failure • NYHA III-IV • SBP <115mmHg • Stroke • Anemia • Men • Age • NYHA III-IV • SBP <115mmHg • Anemia • Renal failure • Hypertension (better) • COPD • Stroke • Diabetes

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

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

  18. HFSIS 2003 – AF

  19. HFSIS 2003 AF – Baseline Characteristics

  20. HFSIS 2003 – Conclusions • In HFSIS 2003national survey of hospitalized HF patients,women were olderthan men and had more comorbidities. • Women hadworse presentationthan men despite abetter 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 higherin 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.

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

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

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