背景:主要心力衰竭(HF)试验在评估临床特征差异方面仍然不足,生物标志物,由于女性的压抑不足,治疗效果和安全性。该研究旨在介绍HF管理中与性别相关的差异,包括人口统计学的差异,合并症,心脏生物标志物,处方药,和治疗结果。
方法:该研究使用了2016年1月1日至2022年12月31日土耳其卫生部国家电子数据库的匿名数据。队列分析包括2,501,231例成人HF患者。使用Cox回归模型分析特定的治疗组合,以获得全因死亡的相对风险降低。主要终点是全因死亡率。
结果:在队列中,48.7%(n=1218911)为男性,51.3%(n=1282320)为女性。女性患者的中位年龄较高(71岁vs.68岁),表现为糖尿病患病率较高,贫血,心房颤动,焦虑,和缺血性中风。男性患者先前的心肌梗塞发生率较高,血脂异常,慢性阻塞性肺疾病,和慢性肾病。在女性患者中观察到较高浓度的利钠肽。RASi,β受体阻滞剂,MRA,SGLT2i,伊伐布雷定更常见于男性患者,而环状利尿剂,地高辛,和羧基麦芽糖铁在女性中更常见。男性患者的CRT和ICD植入率较高。男性患者的全因死亡率和住院率较高。与单一疗法相比,所有组合,包括SGLT2i,对女性和男性HF患者的全因死亡率均有有益的影响。在住院的HF患者中,在RASi中加入地高辛,MRA,在女性HF患者的全因死亡率方面,与男性HF患者相比,β受体阻滞剂优于单药治疗.
结论:结论:本研究强调,与单药治疗相比,对HF药物组合的性别特异性反应以及合并症的差异强调了量身定制管理策略的重要性.在住院后,地高辛对两性的全因死亡率有对比作用,而SGLT2i当添加到所有组合中时,在两种性别中都表现出一致的有益效果。
Major heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the under-representation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from the Turkish Ministry of Health\'s National Electronic Database between January 1, 2016, and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, β blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and β blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on all-cause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations.