GENDER DIFFERENCES IN AN ITALIAN REAL-WORLD COHORT WITH HEART FAILURE: FINDINGS FROM 41 413 PATIENTS OF THE ARNO DATABASE

Delia Colombo, Emanuela Zagni, Stefano Savonitto, Mihaela Nica

Abstract


Background. The real-world evidence of Italian outpatients with heart failure (HF) has been explored using the ARNO database, including more than 40,000 patients.

Methods. This retrospective analysis of the ARNO HF patients explored gender differences in the clinical and therapeutic characteristics, one-year outcomes and health expenditure.

Results. Women were 51.4% of the sample, on average older than men and had developed the disease later in life. Males had significantly higher rates of prior hospital admissions for acute coronary syndrome and higher prescriptions of CV medications. Women suffered more frequently from depression but less from diabetes and COPD. Women showed significantly better 1-year outcome in terms of re-hospitalizations, both for CV and non-CV causes, but not lower mortality. Health costs were lower for women, being hospitalizations the major driver of costs in HF.

Conclusion. This analysis revealed gender differences in HF patients, suggesting the need for more gender-specific studies to develop gender-driven management approaches.


Keywords


Heart failure, gender differences, real-world database.

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Adams, K.F. Jr, Patterson, J.H., Gattis, W.A., O'Connor, C.M., Lee, C.R., Schwartz, T.A. & Gheorghiade, M.(2005) . Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis. J Am Coll Cardiol ;46:497-450.

Aryal, S., Diaz-Guzman, E. & Mannino, D.M.(2013). COPD and gender differences: an update. Transl Res; 162:208-218

Ballo, P., Balzi, D., Barchielli, A., Turco, L., Franconi, F. & Zuppiroli, A.(2016). Gender differences in statin prescription rates, adequacy of dosing, and association of statin therapy with outcome after heart failure hospitalization: a retrospective analysis in a community setting. Eur J Clin Pharmacol; 72:311-319.

Benjamin, EJ., Muntner, P., Alonso, A., Bittencourt, M.S., Callaway, C.W., Carson, A.P., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2019); American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report from the American Heart Association. Circulation: CIR0000000000000659. doi: 10.1161/CIR.0000000000000659.

Bui, AL., Horwich, TB. & Fonarow, GC. (2011). Epidemiology and risk profile of heart failure. Nat Rev Cardiol; 8:30–41.

Charlot, M., Ahlehoff, O., Norgaard, M.L., Jørgensen, C.H., Sørensen, R., Abildstrøm, S.Z., … Gislason, G. (2010). Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med ;153:378–386.

Chin, M.H., Goldman, L.(1998). Gender differences in 1-year survival and quality of life among patients admitted with congestive heart failure. Med Care ;36:1033-1046.

Deswal, A. & Bozkurt, B.(2006). Comparison of morbidity in women versus men with heart failure and preserved ejection fraction. Am J Cardiol;97:1228-1231.

Dunlay, S.M. & Roger, V.L.(2012). Gender differences in the pathophysiology, clinical presentation, and outcomes of ischemic heart failure. Curr Heart Fail Rep;9:267-76.

Faravelli, C., Scarpato, M.A., Castellini, G. & Lo Sauro, C.(2013). Gender differences in depression and anxiety: the role of age. Psychiatry Res ;210:1301-1303.

Forlani, C., Morri, M., Ferrari, B., Dalmonte, E., Menchetti, M., De Ronchi, D. & Atti, A.R. (2014) . Prevalence and gender differences in late-life depression: a population-based study. Am J Geriatr Psychiatry; 22:370-380.

Ghali, J.K., Krause-Steinrauf, H.J., Adams, K.F., Khan, S.S., Rosenberg, Y.D., Yancy, C.W.,… Lindenfeld J(2003). Gender differences in advanced heart failure: Insights from the BEST study. J Am Coll Cardiol; 42:2128–2134.

Gnanasekaran, G.(2011). Epidemiology of depression in heart failure. Heart Fail Clin ;7:1-10

Ibrahim, S.A., Burant, C.J. & Kent Kwoh, C.(2003). Elderly hospitalized patients with diastolic heart failure: lack of gender and ethnic differences in 18-month mortality rates. J Gerontol A Biol Sci Med Sci; 58:56-59.

Jessup, M. & Piña, I.L.(2004). Is it important to examine gender differences in the epidemiology and outcome of severe heart failure? J Thorac Cardiovasc Surg ;127:1247-1252.

Juillière, Y., Berder, V., Brembilla-Perrot, B. & Selton-Suty, C.(2004) Response to drug therapy of cardiac failure according to gender. Arch Mal Coeur Vaiss ;97:1216-1220.

Kao, C.W., Chen, T.Y., Cheng, S.M., Lin, W.S., Friedmann, E. & Thomas, S.A.(2014). Gender differences in the predictors of depression among patients with heart failure. Eur J Cardiovasc Nurs; 13:320-328.

Lam, C.S., Carson, P.E., Anand, I.S., Rector, T.S., Kuskowski, M., Komajda, M., … Kitzman, D.W.(2012). Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: The Irbesartan in Heart Failure with Preserved Ejection Fraction (IPRESERVE) trial. Circ Heart Fail ;5: 571–578.

Maggioni, A.P., Orso, F., Calabria, S., Rossi, E., Cinconze, E., Baldasseroni, S.,… ARNO Observatory(2016). The real-world evidence of heart failure: findings from 41 413 patients of the ARNO database. Eur J Heart Fail ;18:402-410.

McMurray, J.J.V., Packer, M., Desai, A.S., Gong, J., Lefkowitz, M.P., Rizkala, A.R.,… PARADIGM-HF Investigators and Committees.(2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. N Engl J Med;371:993–1004.

Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)(2012). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J ;33:1750–1757.

Nakada, Y., Kawakami, R., Nakano, T., Takitsume, A., Nakagawa, H., Ueda, T.,… Saito, Y.(2016).(2016) Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction. Am J Physiol Heart Circ Physiol ;310:H813-820.

Newhouse, A. & Jiang, W. (2014). Heart failure and depression. Heart Fail Clin;10:295-304.

O’Meara, E., Clayton, T., McEntegart, M.B., McMurray, J.J., Piña, I.L., Granger, C.B.,… CHARM Investigators(2007). Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: Results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation ;115:3111–3120.

Oudit, G.Y., Bakal, J.A., McAlister, F.A. & Ezekowitz, J.A.(2011). Use of oral proton pump inhibitors is not associated with harm in patients with chronic heart failure in an ambulatory setting. Eur J Heart Fail; 13:1211-1215.

Parissis, J.T., Mantziari, L., Kaldoglou, N., Ikonomidis, I., Nikolaou, M., Mebazaa, A.,… Follath, F.(2013). Gender-related differences in patients with acute heart failure: management and predictors of in-hospital mortality. Int J Cardiol ;168:185-189.

Parker, G. & Brotchie, H.(2010). Gender differences in depression. Int Rev Psychiatry ;22:429-436.

Pfeffer, M.A., Swedberg, K., Granger, C.B., Held, P., McMurray, J.J., Michelson, E.L., … CHARM Investigators and Committees.(2003). Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet;362:759–66.

Philbin, E.F.& DiSalvo, T,G,(1998). Influence of race and gender on care process, resource use, and outcomes in congestive heart failure. Am J Cardiol ;82:76-81.

Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G., Coats, A.J., … Authors/Task Force Members; Document Reviewers(2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail ;18:891-975.

Rassen, J.A., Choudhry, N.K., Avorn, J. & Schneeweiss, S.(2009). Cardiovascular outcomes and mortality in patients using clopidogrel with proton pump inhibitors after percutaneous coronary intervention or acute coronary syndrome. Circulation;120:2322–2329.

Ray, W.A., Murray, K.T., Griffin, M.R., Chung, C.P., Smalley, W.E., Hall, K., … Stein, C.M.(2010). Outcomes with concurrent use of clopidogrel and proton-pump inhibitors: a cohort study. Ann Intern Med; 152:337–345.

Roberts, N.J., Patel, I.S. & Partridge, M.R.(2016). The diagnosis of COPD in primary care; gender differences and the role of spirometry. Respir Med ;111:60-63.

Sattar, N.(2013). Gender aspects in type 2 diabetes mellitus and cardiometabolic risk. Best Pract Res Clin Endocrinol Metab ;27:501-507.

Schillinger, W., Teucher, N., Sossalla, S., Kettlewell, S., Werner, C., Raddatz, D., … Hasenfuss, G.(2007). Negative inotropy of the gastric proton pump inhibitor pantoprazole in myocardium from humans and rabbits: evaluation of mechanisms. Circulation ;116:57 –66.

Stein, G.Y., Ben-Gal, T., Kremer, A., Bental, T., Alon, D., Korenfeld, R.,… Fuchs, S.(2013). Gender-related differences in hospitalized heart failure patients. Eur J Heart Fail ;15:734-741.

Stramba-Badiale, M.(2010). Women and research on cardiovascular diseases in Europe: a report from the European Heart Health Strategy (EuroHeart) project. Eur Heart J ;31:1677–1685.

Taylor, A.L.(2015). Heart failure in women. Curr Heart Fail Rep ;12:187-195.

Teerlink, J.R., Cotter, G., Davison, B.A., Felker, G.M., Filippatos, G., Greenberg, B.H., … RELAX in in Acute Heart Failure (RELAX-AHF) (2013). Investigators, Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 2013;381:29–39.

Wallenborn, J. & Angermann, C.E. (2013). Comorbid depression in heart failure. Herz ;38:587-596.

Wändell, P.E. & Carlsson, A.C.(2014). Gender differences and time trends in incidence and prevalence of type 2 diabetes in Sweden--a model explaining the diabetes epidemic worldwide today? Diabetes Res Clin Pract ;106:e90-92.


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