Sex differences in the prognostic role of achieving target doses of heart failure medications: Data from the Swedish Heart Failure Registry.

Autor: Ferrari A; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; MeS (Management and Health) Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy., Stolfo D; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy., Uijl A; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands., Orsini N; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden., Benson L; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden., Sinagra G; Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy., Mol P; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., de Vries ST; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Dahlström U; Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden., Rosano G; Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy.; Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. Georges, University of London, London, UK., Lund LH; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden., Savarese G; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2024 May; Vol. 26 (5), pp. 1101-1110. Date of Electronic Publication: 2024 May 02.
DOI: 10.1002/ejhf.3272
Abstrakt: Aims: Guidelines recommend target doses (TD) of heart failure (HF) with reduced ejection fraction (HFrEF) medications regardless of sex. Differences in pharmacokinetics and pharmacodynamics may explain heterogeneity in treatment response, adverse reactions, and tolerability issues across sexes. The aim of this study was to explore sex-based differences in the association between TD achievement and mortality/morbidity in HFrEF.
Methods and Results: Patients with HFrEF and HF duration ≥6 months registered in the Swedish HF Registry between May 2000 and December 2020 (follow-up until December 2021) were analysed. Treatments of interest were renin-angiotensin system inhibitors (RASI) or angiotensin receptor-neprilysin inhibitors (ARNI), and beta-blockers. Multivariable Cox regression models were performed to explore the risk of cardiovascular mortality or hospitalization for HF across dose categories in females versus males. A total of 17 912 patients were analysed (median age 77.0 years, interquartile range [IQR] 70.0-83.0), 29% were female. Over a median follow-up of 1.33 years (IQR 0.29-3.22), for RASI/ARNI there was no significant difference in outcome for females achieving 50-99% versus 100% of TD (hazard ratio 0.92, 95% confidence interval 0.83-1.03), whereas males showed a gradual lowering in risk together with the achievement of higher % of TD (p-interaction = 0.030). For beta-blockers the achievement of TD was associated with the lowest risk of outcome regardless of sex.
Conclusions: Our findings suggest that females and males might differently benefit from the same dose of RASI/ARNI, and do represent a general call for randomized controlled trials to consider sex-specific up-titration schemes when testing HFrEF treatments in need of up-titration.
(© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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