Background

Despite remarkable improvements in treatment of cardiovascular disease, heart failure (HF) is still characterized by high mortality rate. Sex-specific differences in HF have been described, but underlying reasons are widely unexplored.

Methods

The nationwide German inpatient sample (2005–2016) was used for this sex-specific analyses. Temporal trends on hospitalizations, mortality, and treatments were analysed and independent predictors of adverse outcomes identified.

Results

The analysis comprises 4,538,977 hospitalizations due to HF (52.0%women) in Germany (2005–2016). Although women were older (median 82(IQR75–87) vs.76(69–82),P < 0.001), coronary artery disease (CAD, 50.3% vs. 30.7%,P < 0.001) was more prevalent in men, who were more often treated with percutaneous intervention (PCI;3.4% vs. 1.4%,P < 0.001) and implantable cardioverter-defibrillator (2.2% vs. 0.5%,P < 0.001). In-hospital mortality was significantly lower in men than in women (8.9% vs.10.2%,P = 0.001) and was reduced in patients who received PCI or implantation of an implantable cardioverter-defibrillator.

While total numbers of hospitalizations between 2005 and 2016 increased in both men (β-estimate 7185.71 (95%CI 6502.23 to 7869.18),P < 0.001) and women (β-estimate 5297.60 (95%CI 4557.37 to 6037.83),P < 0.001) as well as almost all comorbid co-conditions, in-hospital mortality rate decreased more distinctly in women (β-estimate −0.41 (95%CI −0.42 to −0.39),P < 0.001) compared to men (β-estimate −0.29 (95%CI −0.30 to −0.27),P < 0.001).

Conclusions

Interventional treatments of HF were associated with improved outcomes and equally beneficial for both sexes. However, they were more often used in male HF patients, in which CAD is significantly more frequent than in female HF patients. This may explain the higher case fatality rate of HF in females.

中文翻译：

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性别差异驱动了德国因心力衰竭住院的患者的时间趋势和结局。

背景

尽管在心血管疾病的治疗方面取得了显着进步，但心力衰竭（HF）仍然具有很高的死亡率。已经描述了HF的性别特异性差异，但根本原因尚待探索。

方法

这项针对性别的分析使用了德国全国住院患者样本（2005-2016年）。分析了住院，死亡率和治疗的时间趋势，并确定了不良后果的独立预测因子。

结果

该分析包括德国（2005-2016年）因心力衰竭（52.0％的女性）导致的4,538,977例住院治疗。尽管女性年龄较大（中位数为82（IQR75-87）对76（69-82），P <0.001），但冠状动脉疾病（CAD，50.3％对30.7％，P <0.001）在男性中更为普遍经皮介入治疗（PCI； 3.4％vs. 1.4％，P <0.001）和植入式心脏复律除颤器（2.2％vs. 0.5％，P <0.001）更常见。男性患者的院内死亡率显着低于女性（8.9％vs.10.2％，P = 0.001），而接受PCI或植入式心脏复律除颤器的患者则降低了。

男性（β估计值为7185.71（95％CI 6502.23至7869.18），P <0.001）和女性（β估计为5297.60（95％CI 4557.37至6037.83），P <0.001 ）以及几乎所有合并症，女性的院内死亡率降低幅度更大（β估计-0.41（95％CI -0.42至-0.39），P <0.001），而男性（β估计- 0.29（95％CI -0.30至-0.27），P <0.001）。

结论

HF的介入治疗与改善的预后相关，并且对男女双方都同样有益。但是，它们在男性HF患者中使用更频繁，其中CAD比女性HF患者更为频繁。这可以解释女性中HF的较高的病死率。