EPOCHA-D-CHF: gender differences in the prognosis of patients with CHF af-ter acute decompensation (part 2*)

Aim. To study effects of gender differences in clinical and epidemiological factors on long-term prognosis for patients with acute decompensated heart failure (ADHF).

Materials and methods. A retrospective, observational analysis of a sample of patients (n=718) hospitalized with signs of ADHF with subsequent collecting information about the endpoint (all-cause death) at four years.

Results. Age was a predictor of unfavorable outcome for both men and women (RR, 1.04, 95% CI, 1.02–1.06, p<0.001 and RR, 1.04, 95% CI, 1.03–1.06, p<0.001). Presence of lower extremity edema increased the risk of fatal outcome for men (RR, 2.03, 95% CI, 1.21-3.39, р=0.007) whereas for women, presence of ascites (RR, 3.43, 95% CI, 2.09-5.64, р<0.001) or orthopneic position on admission (RR, 1.51, 95% CI, 1.03-2.23, p=0.04) resulted in the increased risk. For both sexes, the prediction improved with every 10% increase in systolic BP on admission (RR, 0.87, 95% CI, 0.78–0.97, p=0.01 for men and RR, 0.84, 95% CI, 0.76–0.91, p<0.001 for women). Presence of diabetes mellitus affected the prediction only for women (RR, 1.80, 95% CI, 1.34–2.42, p<0.001). A history of myocardial infarction (RR, 1.40, 95% CI, 1.01–1.95, p=0.04 and RR, 1.44, 95% CI, 1.04–1.98, р=0.03), presence of communityacquired pneumonia (RR, 1.90, 95% CI, 1.32–2.74, p<0.001 and RR, 2.38, 95% CI, 1.55–3.68, p<0.001) adversely affected the prediction for men and women, respectively. At the end of study (4 years), the endpoint (all-cause death) was observed in 65.5% of men and 48.1% of women, median survival was 720 и 1168 days, respectively.

Conclusions. Te long-term prognosis was worse for men hospitalized for ADHF. Presence of congestion signs impaired the prediction for both men and women. Patients with higher systolic BP on admission were characterized with beter survival. A history of diabetes mellitus for women and myocardial infarction or community acquired pneumonia for both sexes worsened the long-term prediction

1. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientifc Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58 (S6):8–164. [Russian]. DOI: 10.18087/cardio.2475

2. Fomin I. V., Belenkov Yu. N., Mareev V. Yu., Ageev F. T., Badin Yu. V., Galyavich A. S. et al. Prevalence of chronic heart failure in European part of Russian Federation – Data of AGE-CHF (Part II). Russian Heart Failure Journal. 2006;7 (3):112–5. [Russian]

3. Deschepper CF, Llamas B. Hypertensive Cardiac Remodeling in Males and Females: From the Bench to the Bedside. Hypertension. 2007;49 (3):401–7. DOI: 10.1161/01.HYP.0000256279.49882.d8

4. Piro M, Della Bona R, Abbate A, Biasucci LM, Crea F. Sex-Related Differences in Myocardial Remodeling. Journal of the American College of Cardiology. 2010;55 (11):1057–65. DOI: 10.1016/j.jacc.2009.09.065

5. Tamura T, Said S, Gerdes AM. Gender-Related Differences in Myocyte Remodeling in Progression to Heart Failure. Hypertension. 1999;33(2):676–80. DOI: 10.1161/01.HYP.33.2.676

6. Maric-Bilkan C, Manigrasso MB. Sex Differences in Hypertension: Contribution of the Renin – Angiotensin System. Gender Medicine. 2012;9(4):287–91. DOI: 10.1016/j.genm.2012.06.005

7. Loyer X, Oliviero P, Damy T, Robidel E, Marote F, Heymes C et al. Effects of sex differences on constitutive nitric oxide synthase expression and activity in response to pressure overload in rats. American Journal of Physiology-Heart and Circulatory Physiology. 2007;293(5):H2650–8. DOI: 10.1152/ajpheart.00883.2007

8. Kanashiro-Takeuchi RM, Heidecker B, Lamirault G, Dharamsi JW, Hare JM. Sex-Specifc Impact of Aldosterone Receptor Antagonism on Ventricular Remodeling and Gene Expression afer Myocardial Infarction. Clinical and Translational Science. 2009;2(2):134–42. DOI: 10.1111/j.1752-8062.2009.00094.x

9. Regitz-Zagrosek V, Seeland U. Sex and gender differences in myocardial hypertrophy and heart failure. Wiener Medizinische Wochenschrif. 2011;161(5–6):109–16. DOI: 10.1007/s10354-011-0892-8

10. Scantlebury DC, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Current Opinion in Cardiology. 2011;26(6):562–8. DOI: 10.1097/HCO.0b013e32834b7faf

11. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival afer the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88(1):107–15. DOI: 10.1161/01.CIR.88.1.107

12. Polyakov D. S., Fomin I. V., Shkarin V. V., Gurvich E. V., Kraiem N. EPOCHA-D–CHF: gender differences in prognosis for acute decompensated heart failoure in real clinical practice (part 1). Women’s health problems. 2017;12 (2):11–21. [Russian]

13. R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. [Internet] 2018. Available at: htps://www.r-project.org/

14. Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Rylova A. K., Pashkevich D. D., Viter K. V. et al. First open study of syndrome of acute decompensation of heart failure and concomitant diseases in Russian Federation: independent registry ORKUL. Kardiologiia. 2015;55 (5):12–21. [Russian]. DOI: 10.18565/cardio.2015.5.12–21

15. Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute Heart Failure: Epidemiology, Risk Factors, and Prevention. Revista Española de Cardiología (English Edition). 2015;68(3):245–8. DOI: 10.1016/j.rec.2014.11.004

16. Jessup M, Piña IL. Is it important to examine gender differences in the epidemiology and outcome of severe heart failure? Te Journal of Toracic and Cardiovascular Surgery. 2004;127(5):1247–52. DOI: 10.1016/j.jtcvs.2003.09.032

17. Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality rate of congestive heart failure in the United States. Journal of the American College of Cardiology. 1992;20(2):301–6. DOI: 10.1016/0735-1097(92)90094-4

18. Chang PP, Chambless LE, Shahar E, Bertoni AG, Russell SD, Ni H et al. Incidence and Survival of Hospitalized Acute Decompensated Heart Failure in Four US Communities (from the Atherosclerosis Risk in Communities Study). Te American Journal of Cardiology. 2014;113(3):504–10. DOI: 10.1016/j.amjcard.2013.10.032

19. Sakata Y, Miyata S, Nochioka K, Miura M, Takada T, Tadaki S et al. Gender differences in clinical characteristics, treatment and longterm outcome in patients with stage C/D heart failure in Japan. Report from the CHART-2 study. Circulation Journal: Ofcial Journal of the Japanese Circulation Society. 2014;78(2):428–35. PMID: 24317114

20. Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS. Pathophysiologic targets in the early phase of acute heart failure syndromes. Te American Journal of Cardiology. 2005;96(6A):11G-17G. PMID: 16196154

21. Dreyer RP, Dharmarajan K, Hsieh AF, Welsh J, Qin L, Krumholz HM. Sex Differences in Trajectories of Risk Afer Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. Circulation: Cardiovascular Quality and Outcomes. 2017;10 (5):165–71. DOI: 10.1161/CIRCOUTCOMES.116.003271

22. Terhoch CB, Moreira HF, Ayub-Ferreira SM, Conceição-Souza GE, Salemi VMC, Chizzola PR et al. Clinical fndings and prognosis of patients hospitalized for acute decompensated heart failure: Analysis of the influence of Chagas etiology and ventricular function. PLOS Neglected Tropical Diseases. 2018;12(2):e0006207. DOI: 10.1371/journal.pntd.0006207

23. Follath F, Yilmaz MB, Delgado JF, Parissis JT, Porcher R, Gayat E et al. Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Medicine. 2011;37(4):619–26. DOI: 10.1007/s00134-010-2113-0

24. Briton K, Gaziano JM, Djoussé L. Normal systolic blood pressure and risk of heart failure in US male physicians. European Journal of Heart Failure. 2009;11 (12):1129–34. DOI: 10.1093/eurjhf/hfp141

25. Levy D. Te progression from hypertension to congestive heart failure. JAMA: Te Journal of the American Medical Association. 1996;275 (20):1557 – 62. DOI: 10.1001/jama.275.20.1557

26. Tsimploulis A, Lam PH, Arundel C, Singh SN, Morgan CJ, Faselis C et al. Systolic Blood Pressure and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. JAMA Cardiology. 2018;3(4):288. DOI: 10.1001/jamacardio.2017.5365

27. Polyakov D. S., Fomin I. V., Badin Yu. V., Vaisberg A. R., Valikulova F. Yu., Shechrbinina E. V. et al. Effects of systolic and diastolic blood pressure and its changes between successive hospitalizations on prognosis for patients with acute decompensated CHF. Russian Heart Failure Journal. 2017;18 (3):178–84. [Rusian]. DOI: 10.18087/rhf.2017.3.2357

28. Georgiopoulou VV, Kalogeropoulos AP, Butler J. Dilemmas of Blood Pressure Management for Heart Failure Prevention. Circulation: Heart Failure. 2011;4(4):528–33. DOI: 10.1161/CIRCHEARTFAILURE.111.961441

29. Dauriz M, Mantovani A, Bonapace S, Verlato G, Zoppini G, Bonora E et al. Prognostic Impact of Diabetes on Long-term Survival Outcomes in Patients with Heart Failure: A Meta-analysis. Diabetes Care. 2017;40(11):1597–605. DOI: 10.2337/dc17-0697

30. Gustafsson I, Brendorp B, Seibæk M, Burchardt H, Hildebrandt P, Køber L et al. Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. Journal of the American College of Cardiology. 2004;43(5):771–7. DOI: 10.1016/j.jacc.2003.11.024

31. Ahmed A, Aban IB, Vaccarino V, Lloyd-Jones DM, Goff DC, Zhao J et al. A propensity-matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age. Heart. 2006;93(12):1584–90. DOI: 10.1136/hrt.2006.113522

32. Scrutinio D, Guida P, Passantino A, Lagioia R, Raimondo R, Venezia M et al. Female gender and mortality risk in decompensated heart failure. European Journal of Internal Medicine. 2018;51:34–40. DOI: 10.1016/j.ejim.2018.01.011

33. Hage F, Hage A, Haddad H, Kiaii B. Update on revascularization in patients with heart failure and coronary artery disease: Current Opinion in Cardiology. 2018;33(2):232–6. DOI: 10.1097/HCO.0000000000000483

34. Karlson BW, Herlitz J, Hartford M. Prognosis in myocardial infarction in relation to gender. American Heart Journal. 1994;128 (3):477–83. DOI: 10.1016/0002-8703(94)90620-3

35. Benderly M, Behar S, Reicher-Reiss H, Boyko V, Goldbourt U. Longterm prognosis of women afer myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. American Journal of Epidemiology. 1997;146(2):153–60. PMID: 9230777

36. Polyakov D. S., Fomin I. V., Vaisberg A. R., Valikulova F. Yu., Ivanchenko E. Yu., Kraiem N. Predictors of community-acquired pneumonia in patients with acute decompensated heart failure: the results of the analysis of the hospital sample EPOHAD-CHF. Terapeutic Archive. 2018,90 (4):35–41. [Russian]. DOI: 10.26442/terarkh201890435-41

37. Tomsen RW, Kasatpibal N, Riis A, Nørgaard M, Sørensen HT. Te Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study. Journal of General Internal Medicine. 2008;23(9):1407–13. DOI: 10.1007/s11606-008-0672-3

38. Arutyunov A. G., Rylova A. K., Arutyunov G. P. Pneumonia in hospitalized patients with circulatory decompensation (Pavlov Hospital Registry). [Russian]

39. Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia: Current Opinion in Infectious Diseases. 2013;26 (2):151–8. DOI: 10.1097/QCO.0b013e32835ebc6d