Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure.

Autor:	Ueberham L; Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany uelaura@web.de., König S; Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany., Hohenstein S; Leipzig Heart Institute, Leipzig, Germany., Mueller-Roething R; Leipzig Heart Institute, Leipzig, Germany., Wiedemann M; Department of Cardiology, HELIOS Hospital Berlin-Buch, Berlin, Germany., Schade A; Department of Cardiology, HELIOS Hospital Erfurt, Erfurt, Thüringen, Germany., Seyfarth M; Department of Cardiology, HELIOS University Hospital Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany., Sause A; Department of Cardiology, HELIOS University Hospital Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany., Neuser H; Department of Internal Medicine II, HELIOS Vogtland Hospital Plauen, Plauen, Sachsen, Germany., Staudt A; Department of Cardiology and Angiology, HELIOS Hospital Schwerin, Schwerin, Germany., Zacharzowsky U; Department of Cardiology, HELIOS Hospital Bad Saarow, Bad Saarow, Brandenburg, Germany., Reithmann C; Department of Internal Medicine I, HELIOS Hospital München West, München, Germany., Shin DI; Department of Cardiology, HELIOS Hospital Krefeld, Krefeld, Nordrhein-Westfalen, Germany., Andrie R; Department of Cardiology, HELIOS Hospital Siegburg, Siegburg, Nordrhein-Westfalen, Germany., Wetzel U; Department of Cardiology, HELIOS Hospital Aue, Aue, Sachsen, Germany., Tebbenjohanns J; Department of Cardiology, HELIOS Hospital Hildesheim, Hildesheim, Niedersachsen, Germany., Wunderlich C; Department of Internal Medicine II, HELIOS Hospital Pirna, Pirna, Sachsen, Germany., Kuhlen R; HELIOS Health GmbH, Berlin, Germany., Hindricks G, Bollmann A
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2020 Apr; Vol. 106 (7), pp. 527-533. Date of Electronic Publication: 2019 Dec 19.
DOI:	10.1136/heartjnl-2019-315566
Abstrakt:	Objective: Atrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study. Methods: Using International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality. Results: Of 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA. Conclusions: There are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice. Competing Interests: Competing interests: GH is receiving grants through the Leipzig Heart Institute from Boston Scientific (Boston Scientific Corporation, Marlborough, Massachusetts, USA) and Abbott/St. Jude Medical (Abbott Laboratories, Chicago, Illinois, USA), no personal payments are to declare. JT is receiving personal fees from Medtronic (Medtronic plc, Minneapolis, Minnesota, USA). The other authors state that there is no conflict of interest. (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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