| Popis: |
Little is known about gender- associated differences in baseline characteristics and outcome in acute heart failure (AHF) pts. The increasing incidence of HF pts obliges to investigate possibilities of their improved management. The aim of the present study was to investigate AHF gender-associated differences that might be used to improve patient treatment, life quality and outcome. A prospective observational study on 22, 713 Emergency (ED) pts was conducted at the Sisters of Mercy University Hospital Center, Zagreb, Croatia, during 2010. The survey included 726 consecutive AHF pts treated at appropriate level of care: Intensive care unit (ICU), Intermediate care or ED. Main outcome measures were clinically relevant gender- associated differences. The secondary outcome measure was the proportion of patients with different types of AHF. Good outcome was defined as discharge from the ED or hospital. In 2010 a total of 22, 713 ED patients were screened, 11, 555 of whom were recorded in the first six months. There was a total of 1, 526 (6.7%) patients with suspected or confirmed AHF, 894 (7.7%) of them in the first six months. Following the exclusion of patients with a false- positive diagnosis (n=151) and engagement of exclusion criteria (n=17), a complete statistical analysis was done on 726 patients ; 409 (56.3%) of those enrolled were women. The patients were allocated into six groups according to the recently published ESC Guidelines for the diagnosis and treatment of AHF: 1) Worsening or decompensation of CHF (49.5%) ; 2) Hypertensive HF (23.6%) ; 3) Isolated right HF (11.8%) ; 4) Pulmonary edema (7.5%) ; 5) Cardiogenic shock (3.8%) ; and 6) ACS and HF (3.8%). Females had a higher SAPS II score (28.5 : 26.6 points ; p=0.001 ; 95% CI 0.76 - 3.11) ; there was no difference in APACHE II score (11.3 : 10.6 points). The overall mortality rate was 67 pts (9.2%). The chief complaint was dyspnea (85.5%). Females suffered more frequently from hypertensive AHF, and males from acute coronary syndrome associated AHF (p=0.046). Females were older (p < 0.001 ; 95% confidence interval [CI] 3.63-6.47), with higher body mass index (p=0.032 ; 95%CI 0.22-4.9), hypertension history (p < 0.001), hypertension at ED presentation (p < 0.001), nitrate administration (p=0.04), atrial fibrillation (p=0.028), digitalis therapy (p=0.011), urinary tract infections (p=0.006). Males had a higher frequency of ST-elevation myocardial infarction (p=0.037), dilated cardiomyopathy (p < 0.001), ultrasound confirmed four chamber dilation (p=0.022), left ventricle dilation (p < 0.001), and lower ejection fraction (p=0.003 ; 95%CI, 2.12- 10.58). In co-morbidities males were more frequently smokers (p < 0.001) with a history of chronic obstructive pulmonary disease (p=0.001). Early identification and treatment of gender-associated co-morbidities might decrease the number of pts suffering from worsening of CHF and improve AHF pts outcome and their life quality. |
