Abstract
AimsHealth insurance claims (HIC) databases in the Netherlands capture unselected patient populations, which makes them suitable for epidemiological research on sex differences. Based on a HIC database, we aimed to reveal sex differences in heart failure (HF) outcomes, with particular focus on co‐morbidities and medication.Methods and resultsThe Achmea HIC database included 14 517 men and 11 259 (45%) women with a diagnosis treatment code for chronic HF by January 2015. We related their sex, co‐morbidities, and medication adherence (medication possession rate >0.8) with the primary endpoint (PE) of all‐cause mortality or HF admission during a median follow‐up of 3.3 years, using Cox regression. Median age of men and women was 72 and 76 years, respectively. Prevalence of co‐morbidities and use of disease‐modifying drugs was higher in men; however, medication adherence was similar. At the end of follow‐up, 35.1% men and 31.8% women had reached the PE. The adjusted hazard ratio for men was 1.25 (95% confidence interval: 1.19–1.30). A broad range of co‐morbidities was associated with the PE. Overall, these associations were stronger in women than in men, particularly for renal insufficiency, chronic obstructive pulmonary disease/asthma, and diabetes. Non‐adherence to disease‐modifying drugs was related with a higher incidence of the PE, with similar effects between sexes.ConclusionsIn a representative sample of the Dutch population, as captured in a HIC database, men with chronic HF had a 25% higher incidence of death or HF admission than women. The impact of co‐morbidities on the outcome was sex dependent, while medication adherence was not.
Highlights
Randomized controlled trials (RCTs) are broadly accepted as the golden standard to evaluate the efficacy and safety of pharmacological treatment
Prescription rates in our study were comparable with the contemporary Dutch CHECK‐heart failure (HF) registry, a more clearly defined HF population, we found lower rates for mineralocorticoid receptor antagonists (MRAs) (40% vs. 56%) and loop diuretics (71% vs. 81%), which can be attributed to focus on HF with reduced ejection fraction (HFrEF) patients who are possibly more symptomatic (26%, New York Health Association III).[15]
Representative sample of the Dutch population, as captured in a Health insurance claims (HIC) database, men with chronic heart failure (CHF) had a 25% higher incidence of death or HF admission than women
Summary
Randomized controlled trials (RCTs) are broadly accepted as the golden standard to evaluate the efficacy and safety of pharmacological treatment. RCTs usually have strict inclusion and exclusion criteria, which makes their representativeness for clinical practice questionable. In the cardiovascular domain, including heart failure (HF), RCT participants are selected from a predominantly (younger) male patient population,[1] whereas (elderly) women and those with more complex diseases are often underrepresented.[2] RCTs insufficiently cover the heterogeneity of the HF population, including the broad variety of socio‐economic factors, the presence of (multiple) co‐morbidities, and medication adherence among men and women. Clinical trial databases are generally less suitable for studying any sex‐specific effect of these factors on HF outcomes.
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