Are there gender differences in management modalities?

Symposium: New insights into the management of acute failure, lessons of the EuroHeart Survey Programme, 750001.

Austria, Vienna, 2 September 2007:

There are major differences in the risk profile and characteristics of female patients treated for acute heart failure. Female patients are underrepresented in management trials on Heart Failure. According to data from the Euro Heart Survey on acute Heart Failure 2004-2005 in Europe, however, medical treatment has improved.

Differencies in gender profile in acute heart failure

Female patients ( m 75 years) are on average 6 years older than male subjects. They represent about 40 – 50% of all acute heart failure hospitalizations. Smoking as risk factor is present only in 15.7% of females compared to 60% in male subjects. Therefore COPD was reported in only 15% of females versus 22% of male subjects. Furthermore the females have less coronary artery disease than males -- 43% compare to 69% in males -- but more hypertension and valvular disease than males. Anemia and thyroid diseases are more prevalent, while renal problems, probably related to atherosclerosis, are more prevalent in male subjects.

Acute coronary syndrome is equally prevalent as precipitating factor in 31% of acute heart failure. Valvular heart disease, arrythmias and especially atrial fibrillation are more prevalent precipitating factors in females. These background characteristics affect medical treatment.

It is noteworthy that less angiography is performed in females (31 % compared to 40%). Similarly, invasive therapies including other catheterizations, balloon pumping and coronary interventions were less frequent.
The difference in interventions may be related to age and clinical picture.

The medical management of male and female patients is very similar.

Aldosterone antagonists, antiarrhythmic drugs, aspirin and lipid lowering drugs were less frequently prescribed to women, whereas they more often received calcium channel blockers, digoxin and insulin at admission. However, after adjustment for clinically significant covariates (age, history CHD and CHF, known systolic dysfunction and atrial fibrillation) there were no statistically significant differences in prescribing cardiovascular medication to women as compared with men. The prescription rate of all cardiovascular medications increased from admission to discharge with the exception of calcium channel blockers which were prescribed less often at discharge.

The female patients in younger or older age groups have better prognosis than male subjects.

The medical management of European females is well justified and no major gender differences can be detected. There are less invasive procedures performed for females probably due to background risk factors and illnesses. Prognosis is better in female than in male subjects.