Gender Differences In Outcomes Research Articles

Gender differences in outcomes after left atrial appendage closure with Watchman FLX device: insights from the Italian-FLX registry

IntroductionRecent studies have shown gender differences in cardiovascular outcomes after left atrial appendage closure (LAAC), highlighting different complication rates and adverse events, particularly in short-term assessments. As a result, there remains a significant knowledge gap on how these differences directly impact the efficacy and safety of LAAC procedures. The aim of this retrospective study was to investigate the clinical outcomes of LAAC in women and men using the Watchman FLX device.MethodsThis retrospective, multicenter study analyzes gender-specific outcomes in 650 patients who underwent LAAC with the Watchman FLX device between March 2019 and May 2022, drawn from the ITALIAN-FLX registry.ResultsThe results show comparable rates of all-cause mortality, stroke, transient ischemic attack and major bleeding in men and women 12 months after the procedure. Notably, no significant gender differences were found for periprocedural complications.ConclusionIn conclusion, this study shows that LAAC with the Watchman FLX device has comparable clinical outcomes between genders at both short-term and long-term follow-up.

Gender differences in outcomes following endoscopic sinus surgery: a systematic review and meta-analysis.

The extent to which gender affects outcomes in chronic rhinosinusitis (CRS) is unclear. The objective of this study was to examine differential outcomes between genders following endoscopic sinus surgery (ESS) among CRS patients. PubMed/Ovid, Embase and Cochrane databases were queried. Outcomes included disease burden on imaging and endoscopy, patient-reported outcome measures (PROMs) including the Sinonasal Outcome Test (SNOT-22), revision rates, and olfactory outcomes. Meta-analysis was performed using the Mantel-Haenszel method with random effects model. Of 4,656 articles screened, 32 (n=103,499) were included for qualitative analysis and four (n=2,602) for meta-analysis. On qualitative analysis, 19 of the 32 studies noted a significant gender difference in post-operative outcomes, with five studies favoring women and 14 favoring men. Nine of 18 studies with PROMs noted a difference between genders, all favoring men. Olfactory outcomes were mixed with studies divided on favoring men vs women. No studies noted significant gender differences of disease burden on imaging or endoscopy. Across four studies included in the meta-analysis, women had higher preoperative and post-operative SNOT-22 scores. Meta-analysis shows that women patients have worse pre and postoperative SNOT-22 scores. Postoperative gender differences are most apparent in studies that examined PROMs. Further research is needed to investigate the underlying causes and to mitigate disparities between genders.

Gender differences in oral appliance treatment of obstructive sleep apnea

PurposeAlthough overall success rates for treating obstructive sleep apnea (OSA) with an oral appliance (OA) are high, they are significantly higher among females. To verify published data, the study’s purpose was to evaluate a participant sample after one year of OA use. The primary outcome was treatment response, with responders defined as having an apnea-hypopnea index (AHI) < 10 at follow-up and/or reduced by ≥50% of baseline. Secondary measures were from standardized questionnaires.MethodsA sample of 314 participants, predominately with moderate-to-severe OSA, were enrolled and instructed to use an OA every night. At baseline and one-year follow-up, polygraphic recordings and questionnaires, including sleepiness (measured using the Epworth sleepiness scale) and quality-of-life (measured using the Functional Outcomes of Sleep Questionnaire), were collected.ResultsAmong the 314 participants, 192 completed the one-year evaluation: 51 females (27%) and 141 males (73%). Overall, OA treatment resulted in 78% and 77% responders among females and males, respectively. Neither the difference in improvement nor the absolute change in AHI differed significantly based on gender, at any OSA severity level. There were no significant gender differences in sleepiness or quality of life. Treatment-related adverse reactions were more common among females.ConclusionBoth females and males with OSA respond well to OA therapy, with nonsignificant gender differences in outcomes. Thus, the hypothesis that females respond better to OA treatment is rejected.

What is the association between gender and self-perceived health status when controlling for disease-specific conditions? A retrospective data analysis of pre- and post-operative EQ-5D-5L differences in total hip and knee arthroplasty

BackgroundThe self-perceived health status of patients undergoing total hip and knee arthroplasty (THA and TKA) might differ post-operatively due to gender, age, or comorbidities. Patient-reported outcome measures (PROMs) such as the EQ-5D-5L measure the self-perceived health status. This study investigates whether the index score of the EQ-5D-5L is a valid tool for interpreting gender differences in outcomes for patients undergoing THA and TKA.MethodsRoutine and PROM-data of elective primary THA or TKA patients in two German hospitals between 2016 and 2018 were analyzed. Univariate analysis with Pearson’s chi-square was conducted to identify control variables for gender. To quantify the association between gender and the EQ-5D-5L dimensions, a cumulative odds ordinal logistic regression with proportional odds was conducted.ResultsTwo thousand three hundred sixty-eight​​ THA patients (m = 978; f = 1390) and 1629 TKA patients (m = 715; f = 914) were considered. The regression analysis of the individual EQ-5D-5L dimensions showed that female gender was significantly associated with better self-care (THA and TKA) and better post-operative mobility (THA). In contrast, male gender was significantly associated with less pain/discomfort (TKA) and less anxiety/depression (THA) pre-surgery and 3-months post-surgery.ConclusionOur results confirmed that the self-perceived health status improved after surgery. However, due to the different associations of gender to the individual dimensions of the EQ-5D-5L, the weighted index score clouds the comparability between patients with different gender undergoing THA or TKA. Therefore, we argue to use the individual five dimensions for health status analysis, to reveal relevant additional information.

Gender-Based Differences in Outcomes After Percutaneous Coronary Intervention of Chronic Total Occlusions (Insights from a Large Single-Center Registry)

Patients who undergo percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) are at a high risk for both periprocedural and post-procedural adverse events. Whether gender-differences in outcomes exist after PCI of CTO remain unclear. Therefore, we sought to investigate gender-based differences in outcomes after CTO-PCI. All patients who underwent elective CTO intervention from January 2012 to December 2017 at The Mount Sinai Hospital (New York, New York) were included. The primary end point of interest was major adverse cardiac events defined as the composite of death, myocardial infarction, and target vessel revascularization at 1year of follow-up. A total 1,897 patients were included, of which 368 were women (19.4%). Mean follow-up time was 174days. Women were older (66.8 ± 11.3years vs 62.6 ± 10.9years) and had a higher prevalence of co-morbidities including diabetes and chronic kidney disease. There were no significant differences in the rate of successful CTO-PCI between groups (73.5% vs 73.2%, p=0.91). Women had higher rates of procedure-related complications including increased risk of post-procedural bleeding (4.1% vs 1.8%, p=0.009) and acute vessel closure (1.36% vs 0.2%, p=0.009). In multivariable-adjusted analysis, female gender was associated with higher risk of major adverse cardiac event and target vessel revascularization at 1year. In conclusion, in this large single-center study, women who underwent percutaneous CTO revascularization experienced higher rates of periprocedural complications and worse clinical outcomes at 1year compared with men. Further research is needed to address disparities in gender-specific outcomes of CTO-PCI.

Gender differences in prosthesis-related outcomes among veterans: Results of a national survey of U.S. veterans.

Women with lower extremity amputations (LEAs) tend to have poorer prosthesis-related outcomes than men, although the literature is sparse. To our knowledge, there are no prior studies examining prosthesis-related outcomes of women veterans with LEAs. To examine gender differences (overall and by type of amputation) among veterans who underwent LEAs between 2005 and 2018, received care at the Veterans Health Administration (VHA) prior to undergoing amputation, and were prescribed a prosthesis. It was hypothesized that compared to men, women would report lower satisfaction with prosthetic services, poorer prosthesis fit, lower prosthesis satisfaction, less prosthesis use, and worse self-reported mobility. Furthermore, it was hypothesized that gender differences in outcomes would be more pronounced among individuals with transfemoral than among those with transtibial amputations. Cross-sectional survey. Linear regressions were used to assess overall gender differences in outcomes and gender differences based on type of amputation in a national sample of veterans. VHA medical centers. The sample consisted of 449 veterans who self-identified their gender (women = 165, men = 284) with transtibial (n = 236), transfemoral (n = 135), and bilateral LEAs (n = 68) including all amputation etiologies. Not applicable. The Orthotics and Prosthetics User's Survey, Trinity Amputation and Prosthesis Experiences Scale, and Prosthetic Limb Users Survey of Mobility-Short Form were used to assess satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, prosthesis use, and self-reported mobility. Women had poorer self-reported mobility than men (d = -0.26, 95% confidence interval -0.49 to -0.02, p < .05); this difference was small. There were no statistically significant gender differences in satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, daily hours of prosthesis use, or by amputation type. Contrary to the hypothesis, prosthesis-related outcomes were similar between men and women with LEAs. Minimal differences may in part be due to receiving care from the VHA's integrated Amputation System of Care.

AB-452665-1 GENDER BASED DIFFERENCES IN SAFETY AND OUTCOMES OF CATHETER ABLATION PROCEDURE FOR ATRIAL FIBRILLATION

Studies have identified significant sex-based differences and disparities in the clinical presentation and treatment of atrial fibrillation (AF). Women are less likely to be referred for catheter ablation, are older at the time of ablation, and are more likely to have recurrence after ablation. It is important to note, however, that in most studies investigating AF ablation outcomes, the female cohorts were relatively small. The impact of gender on the outcome and safety of ablation procedures is still unclear due to the paucity of evidence on the topic. To investigate gender differences in outcomes and complications after AF catheter ablation, with a significant size female cohort in the study population In this retrospective observational study, patients undergoing first catheter ablation for AF from January 1, 2014, to March 31, 2021, were included. We investigated clinical characteristics, duration and progression of AF, number of electrophysiologist appointments (EP) from diagnosis to ablation, procedural data, and procedure complications. The primary endpoint of this study was arrhythmia recurrence, and the secondary endpoints were procedural complications and redo ablation. Total 1346 patients underwent first catheter ablation for AF during this period, including 896 (66.5%) male and 450 (33.4%) female patients (Table 1). Female patients were older at the time of ablation (66.2y vs 62.4y; p<0.001). Women had higher CHA2DS2-VASc scores (3 vs 2; p<0.001) than men, expectedly, as the female sex warrants an additional point. 25.3% female patients had persistent AF (PersAF) at the time of diagnosis vs 35.3% male patients (p<0.001). At the time of ablation, 31.8% female patients had PersAF as compared to 43.1% male patients (p<0.001), indicating progression of paroxysmal AF (PAF) to PersAF in both genders. Female group presented for more EP appointments and tried more antiarrhythmic drugs (AADs) than the male group before ablation (1.13 vs 0.98; p=0.002). Male and female patients had no statistically significant difference in (a) arrhythmia recurrence at 1-y post ablation (27.7% vs 30%; p=0.38) or (b) procedural complication rate (1.8% vs 3.1%; p=0.56). Female patients were older and had higher CHA2DS2-VASc scores compared to males at the time of AF ablation. Female patients tried more AADs and visited with electrophysiologists more leading up to ablation. 1-y arrhythmia recurrence rates and procedural complications were similar in both genders.

Gender Differences in Clinical Outcomes After Percutaneous Coronary Intervention—Analysis of 15,106 Patients from the Cardiac Registry of Pakistan Database

There is a scarcity of data on gender differences in outcomes during and after percutaneous coronary intervention (PCI) in the South Asian population. We assessed the gender differences in in-hospital mortality and complications in patients who underwent PCI. We conducted a cross-sectional study of 15,106 patients from the CROP (Cardiac Registry of Pakistan) CathPCI database. Logistic regression was used to determine factors associated with in-hospital mortality (primary outcome), access site hematoma, and bleeding complications. Approximately 19.6% were women. Women were older (mean age = 57.3 vs 54.4 years) and had a higher prevalence of diabetes (49.3% vs 32.6%), hypertension (72.8% vs 56.4%), peripheral arterial disease (1.5% vs 1%), and cerebrovascular accident (1.2% vs 0.8%) than men (p <0.05).Unadjusted in-hospital mortality was higher in women than in men (odds ratio [OR]: 1.6, 95% confidence interval [CI] 1.1 to 2.2); however, after adjusting for age, hypertension, diabetes, history of cerebrovascular accident, and ST-elevation myocardial infarction at presentation in the multiple logistic regression model, in-hospital mortality was comparable between men and women (adjusted OR [AOR] 1.2, 95% CI 0.8 to 1.7). The results remained consistent after propensity score matching of 5,904 patients (2,952 in each group, OR 1.3, 95% CI 0.9 to 2.0 for in-hospital mortality). Bleeding complications (1.2% vs 0.4%, AOR 2.6, 95% CI 1.4 to 4.5) and access site hematoma (2% vs 0.6%, AOR 2.8, 95% CI 1.8 to 4.5) were higher in women than in men. In conclusion, the incidence of in-hospital mortality was higher for women versus men, but adjusted risks were similar, likely driven by a greater co-morbidity burden among women.

Abstract 14682: Gender Disparities in Hypertrophic Cardiomyopathy After Septal Myectomy - Insights From the National Inpatient Sample 2011-2019

Introduction: Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce. Methods: The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value &lt;0.001 was considered statistically significant. Results: We identified 10,805 patients with HCM who underwent SM, of which 55.4% were female. Women were significantly older (60.9 vs. 56.3 years), had more obesity (31% vs. 26.8%), heart failure (44.6% vs. 40%), chronic obstructive pulmonary disease (12.2% vs. 9.2%) and pulmonary hypertension (16.2% vs. 11.5%) (p&lt;0.001 for all) compared to men. Men had more hypertension (75.4% vs. 69.7%), tobacco use (41.5% vs. 34%), alcohol use (3.5% vs. 1.4%), hyperlipidemia (59.3% vs. 55.6%), obstructive sleep apnea (25.9% vs. 15%), coronary artery disease 41% vs. 32%), chronic kidney disease (12.6% vs. 8.7%), atrial fibrillation (46% vs. 40.9%), and atrial flutter (8.5% vs. 4.7%) (p&lt;0.001 for all) compared to women. In-hospital outcomes demonstrate women had higher all-cause mortality (3.3% vs. 1.6%, OR: 2.4 [1.5-4]) and more frequently required intra-aortic balloon pump placement (OR: 6.9 [2.7-19]) compared to men. Men had more intraoperative cardiac complications (OR: 1.4 [1.1-1.6]), pneumothorax (OR: 1.7 [1.25-2.5]), and pericardial complications (OR: 10 [3-33]) (p&lt;0.001 for all) compared to women. Conclusions: In patients with HCM who underwent SM, women had higher all-cause mortality despite having less comorbidities than men. These highlights potential gender differences in outcomes in patients referred for SM. Whether biases exist in referral patterns needs to be further elucidated.

Acute ST-elevation myocardial infarction: are men and women particular cases of STEMI ?

Abstract Funding Acknowledgements Type of funding sources: None. Background ST-segment elevation myocardial infarction (STEMI) has high levels of morbidity and mortality. Multiple risk factors may contribute to clinical outcomes and some studies demonstrate gender-related differences in baseline characteristics and in-hospital management. Purpose To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis. Methods We retrospectively analyzed 121 non-consecutive patients with STEMI during a mean follow-up period 135 ± 31 weeks. We accessed baseline characteristics and time course of events (symptom onset-to-door admission; time to first EKG; time to fibrinolytic therapy; door-to-cath lab time and time from fibrinolytic therapy to PCI (for patients transferred from another centers). Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV. Secondary endpoint (SE) was in-hospital major bleeding events, considered intracerebral hemorrhage, cases of hemodynamic compromise or requiring a blood transfusion. Tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality. Results Of the 121 patients, 102 were male (84.3%) and 19 (15.7%) female. The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years) vs. Men mean age 56 ± 11.6 years. Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes (vs 10.8% of men) and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021). According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014). Conversely, less women smoke (31.6% vs. 82.2%; p &amp;lt;0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04). Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes). Regarding to in-hospital hemorrhagic events (secondary endpoint), female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r=0.249; ANOVA p-value &amp;lt; 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes or survival function were observed. Conclusion Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.

Gender Differences in Psychiatric Symptoms and the Social Functioning of 610 Patients with Schizophrenia in Urban China: A 10-Year Follow-Up Study.

PurposeTo explore the different outcomes between male and female patients with schizophrenia after long-term follow-up.Patients and MethodsSchizophrenia patients were participants in our study. First, two senior psychiatrists collected data on the demographic characteristics and clinical symptoms of patients from the Hospital Information System between February 2009 and January 2010. Second, two other senior psychiatrists called the patients and their guardians between February 2019 and January 2020 to get general information on the patients and assess their psychiatric symptoms and social functioning using the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance (PSP) scale.ResultsOf the 610 participants, the 306 female participants were younger (48.32 ± 12.99 vs 49.84 ± 12.60) and had received more education (8.08 ± 3.76 vs 7.94 ±3 0.73). After 10 years, women were found to have more outpatient visits than men (20.86 ± 22.21 vs 16.11 ± 16.87, P < 0.05). However, there was no significant gender difference in number of hospitalizations (3.12 ± 5.34 vs 2.77 ± 5.84, P > 0.05). The PANSS scores were lower for both groups at the 10-year follow-up. Women had significantly lower scores than men after the 10-year period (P < 0.05). With regard to social functioning, there was a significant difference in social functioning between baseline scores and 10-year follow-up scores indicating an improvement in social functioning. PSP scores had significantly increased in women (P < 0.01) but not in men (P > 0.05).ConclusionFemale patients had significantly lower levels of psychiatric symptoms and higher levels of social functioning at 10-year follow-up than male patients. They also reported more outpatient visits, which may have contributed to the gender differences in outcomes. Family members and doctors of patients should urge patients to make regular outpatient visits for better outcomes after hospitalization.

Gender Disparities in Cardiogenic Shock Treatment and Outcomes

Cardiogenic shock is associated with a high risk for morbidity and mortality. The impact of gender on treatment and outcomes is poorly defined. This study aimed to evaluate whether gender influences the clinical management and outcomes of patients with prehospital cardiogenic shock. Consecutive adult patients with cardiogenic shock who were transferred to hospital by emergency medical services (EMS) between January 1, 2015 and June 30, 2019 in Victoria, Australia were included. Data were obtained from individually linked ambulance, hospital, and state death index datasets. The primary outcome assessed was 30-day mortality, stratified by patient gender. Propensity score matching was performed for risk adjustment. Over the study period a total of 3,465 patients were identified and 1,389 patients (40.1%) were women. Propensity score matching yielded 1,330 matched pairs with no differences observed in baseline characteristics, including age, initial vital signs, pre-existing co-morbidities, etiology of shock, and prehospital interventions. In the matched cohort, women had higher rates of 30-day mortality (44.7% vs 39.2%, p=0.009), underwent less coronary angiography (18.3% vs 27.2%, p <0.001), and revascularization with percutaneous coronary intervention (8.9% vs 14.2%, p <0.001), compared with men. In conclusion, in this large population-based study, women with cardiogenic shock who were transferred by EMS to hospital had significantly worse survival outcomes and reduced rates of invasive cardiac interventions compared to men. These data underscore the urgent need for targeted public health measures to redress gender differences in outcomes and variation with clinical care for patients with cardiogenic shock.

ACUTE ST-ELEVATION MYOCARDIAL INFARCTION: ARE MEN AND WOMEN PARTICULAR CASES OF STEMI?

Objective: To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis. Design and method: We retrospectively analyzed 121 patients with STEMI, during a mean follow-up period 135 ± 31 weeks. We accessed baseline characteristics and time course of events. Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV. Secondary endpoint (SE) was in-hospital major bleeding events and tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality. Results: Of the 121 patients, 102 were male (84.3%). The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years). Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021). According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014). Conversely, less women smoke (31.6% vs. 82.2%; p &lt; 0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04). Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes). Regarding to in-hospital hemorrhagic events, female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r = 0.249; ANOVA p-value &lt; 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes were observed. Conclusions: Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.

Propensity Score-Matched Comparison of Right Ventricular Strain in Women and Men Before and After Left Ventricular Assist Device Implantation.

Objective: Adverse events following left ventricular assist device (LVAD) implantation are more common in women than in men, but the impact of gender differences on right ventricular (RV) failure is not well defined. Therefore, we calculated RV strain before and after LVAD implantation in matched groups of men and women to determine if gender differences in RV failure after LVAD might account for the gender differences in overall outcomes. Methods: RV free wall longitudinal strain (FWS) and fractional area change were calculated preoperatively and 3 months postoperatively using speckle-tracking echocardiography analysis. A total of 172 patients (86 women, 86 men) were then propensity score matched (1:1) for comparison. Results: Although women had higher preoperative CHA2DS2-VASc scores and more frequent moderate mitral regurgitation than men (P = 0.018), the preoperative hemodynamic parameters were similar. Preoperative RV-FWS was -6.7% in women and -6.0% in men (P = 0.65). Postoperatively, women had more progression to severe tricuspid regurgitation (TR) than men (15% vs 7%, P = 0.06). At 3 months the RV-FWS was -7.7% in women and -7.0% in men (P = 0.59). Postoperative TR was moderate-severe in 20% of women and in 9% of men (P = 0.001). Women had a higher incidence of venous thromboembolism, cardiac arrhythmias, and bleeding compared with men. Women also had higher mortality rates at discharge and 30 days after surgery, but the survival rates at 5 years were similar. Conclusions: RV strain measurements track standard hemodynamic and echocardiographic parameters and confirm that gender differences in outcomes following LVAD implantation are not related to gender differences in RV failure rates.

Gender differences in outcome in patients with diabetes mellitus

BackgroundDiabetes mellitus is an independent risk factor in the development of coronary artery disease (CAD), myocardial infarction (MI), and cardiac death (CD). The major adverse cardiac events (MACEs) between men and women in diabetic patients stratified by CAD (previous MI and/or coronary revascularization, CR) were analyzed. Methods and ResultsA cohort of 1327 consecutive diabetic patients (age 66.5 ± 9 years) underwent gated SPECT (single-photon emission computed tomography). During a mean follow-up of 4.7 ± 2.2 years post gated SPECT, MACEs (non-fatal MI, CD, and late CR) were evaluated according to gender stratified by CAD. Among diabetic patients without known CAD (N = 731), men had more MACEs (sHR 1.9;95%CI 1.2-3.2) than women. Among diabetic patients with known CAD (N = 596), there was no difference in MACEs in diabetic men and women (sHR 1.15;95%CI 0.73-1.8). Diabetic women with known CAD (n = 143) were the group with the highest risk (sHR 1.7; P = .041) for MACEs (4.5% MACEs/year, [95%CI 3.1%-6.4%]), compared to the remaining diabetic patients (N = 1184) (3% MACEs/year, [95%CI 2.6%-3.5%]). ConclusionsThe prognosis of diabetic patients for MACEs is different in men and women stratified by CAD. The worst prognosis for MACEs occurs in women with known CAD.

Gender Differences in Age-Stratified Inhospital Outcomes After Transcatheter Aortic Valve Implantation (from the National Inpatient Sample 2012 to 2018)

Contemporary data on gender differences in outcomes after transcatheter aortic valve implantation (TAVI), after stratification by age, remain limited. We studied age-stratified (60 to 70, 71 to 80, and 81 to 90 years) inhospital outcomes by gender after TAVI from the National Inpatient Sample database between 2012 and 2018. We analyzed National Inpatient Sample data using the International Classification of Diseases, Clinical Modification, Ninth Revision, and Tenth Revision claims codes. Between the years 2012 and 2018, a total of 188,325 weighted hospitalizations for TAVI were included in the analysis. A total of 21,957 patients were included in the 60 to 70 age group (44% females), 60,770 (45% females) in the 71 to 80 age group, and 105,580 (50% females) in the 81 to 90 age groups, respectively. Propensity-matched inhospital mortality rates were significantly higher for females than males for the age group of 81 to 90 years (3.0% vs 2.1%, p <0.01). Vascular complications and a need for blood transfusions remained significantly higher for females on propensity-matched analysis across all categories of ages. Conversely, acute kidney injury and the need for pacemaker implantation remained significantly higher for males across all age groups. In conclusion, we report that mortality is higher in female patients who underwent TAVI between the ages of 81 to 90. Moreover, the female gender was associated with higher vascular complications and bleeding requiring transfusions. Conversely, the male gender was associated with higher rates of pacemaker implantation and acute kidney injury.

Abstract 10846: Gender Differences in Outcomes of Mitraclip: A Meta-Analysis

Introduction: With the approval of transcatheter mitral valve edge-edge repair (TEER) for secondary mitral regurgitation, there has been a significant increase in the volume of TEER. Prior investigators have explored gender differences in outcomes of Mitraclip (the only approved TEER) with mixed results. In this study, we systematically reviewed impact of gender on Mitraclip outcomes and performed a meta-analysis to examine short-term and long-term outcomes in women versus men. Hypothesis: Females undergoing TEER with Mitraclip will have higher mortality, major adverse events and less functional improvement compared to men. Methods: Pubmed, Google scholar, Cochrane database etc were searched through 31 May 2021 for published studies reporting outcomes with Mitraclip in women versus men. Meta-analysis was performed using comprehensive meta-analysis software using random effects model. Results: Ten studies (8 manuscripts and 2 abstracts) with total of 2924 males and 1816 females were analysed. The risk of death at discharge (p=0.71), at 30 days (p=0.32) and beyond 6-12 months (p=0.97) was similar. Acute procedural success (defined by mitral regurgitation grade ≤2 at 30 days), major adverse events at 1 month (p=0.064) and at 1 year (p= 0.98), risk of renal failure (p=0.15), stroke (p=0.71) and 1 year readmission rate (p=0.42) were all similar. Females received more blood transfusion than males (RR: 1.37, CI: 1.03-1.80, p=0.02). Prevalence of NYHA 3/4 class at 1 year post-procedure (RR: 1.36, CI: 1.19-1.56, p&lt;0.01) and MLHFQ scores (RR: 1.91, CI: 1.47-2.48, p=0.01) were higher in females compared to males. Conclusions: Females have similar early and intermediate term mortality, major adverse events and rehospitalization rates compared to men following TEER with Mitraclip. However, females have less symptoms improvement as evidenced by greater frequency of NYHA class 3/4 symptoms and higher MLHFQ scores at 6-12 months after Mitraclip implantation compared to males.

Gender difference in outcomes of patients undergoing MitraClip therapy: A systematic review and meta-analysis

IntroductionTranscatheter edge-to-edge repair (TEER) of the mitral valve with MitraClip therapy is an emerging treatment in selected patients with severe mitral regurgitation. Identifying the patient with increased risk of poorer outcomes, including mortality, is crucial in these patients. Recent studies suggested conflicting data regarding the effects of gender on outcome in this patient population. We evaluate the impact of gender on the outcome of patients undergoing MitraClip therapy by systematic review and meta-analysis. MethodsThe authors comprehensively searched the databases of EMBASE and MEDLINE from inception to April 2021. Included studies were published cohorts reporting univariate or multivariate analysis of the effects of gender on in-hospital and overall mortality among patients undergoing MitraClip therapy. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonioan and Laird. ResultsA total of nine studies were included in this meta-analysis, including 9062 patients. Male gender is associated with higher in-hospital mortality with pooled OR 1.81 (95% confidence interval 1.01–3.22, p-value 0.045) and overall mortality with pooled OR 1.19 (95% CI 1.06–1.33, p-value 0.003). ConclusionsAccording to our meta-analysis, the male gender increases the risk of in-hospital mortality up to 1.81 folds and overall mortality up to 1.19 folds.

Sex and Gender in COVID-19 Vaccine Research: Substantial Evidence Gaps Remain.

Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.

Do in-hospital outcomes of isolated coronary artery bypass grafting vary between male and female octogenarians?

OBJECTIVESFemale gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort.METHODSAll octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived.RESULTSFive hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30–49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts.CONCLUSIONSNo gender difference in outcomes was seen in octogenarians undergoing isolated CABG.