Sex-specific acute heart failure phenotypes and outcomes from PROTECT
Sex-specific acute heart failure phenotypes and outcomes from PROTECT
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DOI：
10.1093/eurjhf/hft115
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发表时间：
2013-12-01
影响因子：
18.2
通讯作者：
Voors, Adriaan A.
中科院分区：
文献类型：
--
作者：
Meyer, Sven;van der Meer, Peter;Voors, Adriaan A.
男性和女性在急性心力衰竭的表现、治疗和结局方面的差异还没有得到很好的研究。本研究的目的是分析急性心力衰竭患者的临床表现、住院和出院后转归的性别差异。对2033例因急性心力衰竭和肾功能受损而住院的患者的临床资料、治疗特点和转归进行性别比较。女性占研究人群的33%，年龄较大，身体质量指数、左心室射血分数和收缩压较高，糖尿病患病率较高。在基线时，女性表现出与男性相似的充血体征和症状，但更常见的是罗音、矫形呼吸暂停和更差的肾功能。女性的饮食强度较低，如口服和静脉注射利尿剂剂量较低，剂量增加较少，住院期间总体重减轻较少。此外，女性的住院天数略有延长(11.047.8天比10.65.86天；P 0.024)。年龄调整后的180d死亡率女性较低(15.8vs.18.5vs.18.5，风险比0.74；95可信区间0.590.93，P 0.010)，但男女多变量风险调整死亡率相似，主要归因于女性较低的血尿素氮、较高的左心室射血分数和较高的收缩压。女性急性心力衰竭的临床特征与男性不同，有更多的高血压、糖尿病和抑郁症，左心室射血分数保持不变。在住院期间，他们的饮食强度较低。尽管如此，风险调整后的180天结果在性别之间是相似的。
Differences in manifestation, treatment, and outcomes of acute heart failure between men and women have not been well studied. The objective of this analysis was to characterize differences in clinical presentation, and in-hospital and post-discharge outcomes between sexes in acute heart failure patients.Clinical profiles, treatment characteristics, and outcomes were compared between sexes in 2033 patients hospitalized for acute heart failure and impaired renal function. Women comprised 33 of the study population and were older, had higher body mass index, LVEF, and systolic blood pressure, and a greater prevalence of diabetes. At baseline, women showed signs and symptoms of congestion comparable with men, but more often had rales, orthopnoea, and worse renal function. Women were less intensively diuresed, as indicated by lower oral and intravenous diuretic doses used, fewer dose increases, and less total weight loss during hospitalization. Furthermore, hospitalization was slightly but significantly prolonged in women (11.04 7.8 vs. 10.65 8.86 days; P 0.024). Age-adjusted 180-day mortality was lower in women (15.8 vs. 18.5, hazard ratio 0.74; 95 confidence interval 0.590.93, P 0.010), but multivariable risk-adjusted mortality was similar in both sexes, mainly attributable to lower blood urea nitrogen, higher LVEF, and higher systolic blood pressure in women compared with men.Women with acute heart failure present with a clinical profile different from that of men, with more hypertension, diabetes, and depression, and a preserved LVEF. During hospitalization, they were less intensively diuresed. Nevertheless, risk-adjusted 180-day outcome was similar between sexes.