497 NHS Heart Failure Survey - Acute heart failure admissions in England, Wales and Northern Ireland - demographics, clinical presentation and pre-admission pharmacology

Abstract

Background: The natural history of heart failure (HF) may be different in women, because of its different clinical profile, management and response to treatment. In addition, there are few and contradictory data about the prognosis of women. Our aim was to study the long-term prognosis, and its determinants, in a large population of women hospitalized with acute HF. Methods: We prospectively evaluated all patients discharged with HF diagnosis, from the cardiology department of a tertiary university hospital, between january 2002 and december 2004 (n=412). Clinical variables, blood samples and electrocardiogram were obtained previous to discharge and an echocardiography was carried out during the hospitalisation. Patients were followed during 15±9 months and all-cause mortality was registered. Results: In comparison with men, women (n=157, 38%) were older (75 [68-80] vs. 71 [59-77] years, p<0.001), with higher prevalence of arterial hypertension (71% vs. 51%, p<0.001) and previous hospitalisations due to HF (36% vs. 25%, p=0.02). Women differed in HF aetiology, with higher rate of hypertensive myocardiopathy (17% vs. 8%, p=0.006) and lower of coronary disease (34% vs. 49%, p=0.007). Women were received less treated with antiplatelets (45% vs 62%, p=0.001), betablockers (39% vs 50%, p=0.03) and statins (31% vs 45%, p=0.003). On discharge, women had lower levels of haemoglobin (12.1±1.7 vs 12.9±1.9, p<0.001), glomerular filtration rate (51.7 [25] vs 51.7 [26], p<0.001), serum creatinine (1.1[0.5] vs 1.3[0.4], p<0.001) and uric acid (7.3[2.2] vs 7.9[2.9], p=0.021). Women had higher LVEF (40%[29] vs 35%[15], p<0.001). During follow-up, 35 (23%) women died. The cumulative probability of death for women was 11%, 17% and 24% at 6, 12 and 18months, respectively, which did not differ frommen (8%, 12% and 17%, p=0.215). In Cox regression multivariate analysis, the independents predictors of death in women were age (RR 1.05 [1.01-1.10], p=0.01), anemia (OMS) (RR 1.04 [1.10-3.78], p=0.02), previous HF hospitalisation (2.10 [1.20-3.68], p=0.01) and not be treated with rennin-angiotensin system inhibitors (2.08 [1.02-4.24], p=0.04). Conclusions: Women hospitalized because HF had a different clinical profile, but its long-term prognosis was similar to men. We identify age, anaemia, previous hospitalisation because HF and no ACE inhibitors therapy as independent predictors of death in women.