Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure

Carolyn S P Lam; Peter Chang; Shaw Yang Chia; Ling Ling Sim; Fei Gao; Fong Ling Lee; Ping Chai; Raymond Ching-Chiew Wong; Swee Chong Seow; Gerard Kui Toh Leong; Poh Shuan Daniel Yeo; David Sim; Terrance Chua; Bernard W K Kwok

doi:10.7603/s40602-014-0008-y

Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure

ASEAN Heart J. 2014;22(1):8. doi: 10.7603/s40602-014-0008-y.

Affiliations

¹ National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore.
² National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore.
³ Khoo Teck Puat Hospital, Department of Cardiology, Singapore, Singapore.
⁴ Changi General Hospital, Department of Cardiology, Singapore, Singapore.
⁵ Tan Tock Seng Hospital, Department of Cardiology, Singapore, Singapore ; Singapore Cardiac Data Bank, Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore, Singapore.

Abstract

Objectives: To study sex differences in clinical characteristics and outcomes among multi-ethnic Southeast Asian patients with hospitalized heart failure (HHF).

Background: HHF is an important public health problem affecting man and women globally. Reports from Western populations suggest striking sex differences in risk factors and outcomes in HHF. However, this has not been studied in a multi-ethnic Asian population.

Methods: Using the population-based resources of the Singapore Cardiac Data Bank, we studied 5,703 consecutive cases of HHF admitted across hospitals in the Southeast Asian nation of Singapore from 1st January, 2008 through 31st December, 2009.

Results: Women accounted for 46% of total admissions and were characterized by older age (73 vs. 67 years; p<0.001), higher prevalence of hypertension (78.6 vs. 72.1%; p<0.001) or atrial fibrillation (22.2 vs. 18.1%; p<0.001), and lower prevalence of coronary artery disease (33.8 vs. 41.0%; p<0.001) or prior myocardial infarction (14.9 vs. 19.8%; p<0.001). Women were more likely than men to have HHF with preserved ejection fraction (42.5% versus 20.8%, p < 0.001). Women were less likely than men to receive evidencebased therapies at discharge, both in the overall group and in the sub-group with reduced ejection fraction. Women had longer lengths of stay (5.6 vs. 5.1 days; p<0.001) but similar in-hospital mortality and one-year rehospitalization rates compared to men. Independent predictors of mortality or rehospitalization in both men and women included prior myocardial infarction and reduced ejection fraction. Among women alone, additional independent predictors were renal impairment, atrial fibrillation, and diabetes. Prescription of beta-blockers and ACE-inhibitors at discharge was associated with better outcomes.

Conclusion: Among multi-ethnic Asian patients with HHF, there are important sex differences in clinical characteristics and prognostic factors. These data may inform sex-specific strategies to improve outcomes of HHF in Southeast Asians.

Keywords: Characteristics; Congestive heart failure; Sex; Treatment.