Gender-related Differences In Patients Research Articles

Gender-related differences in presentation and treatment of patients with non-valvular atrial fibrillation: results from RAMSES study.

Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multicenter, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p<0.001), had lower frequency of coronary artery disease (22.0% vs. 38.3%; p<0.001) and congestive heart failure (18.2% vs. 27.2%; p<0.001). Women had higher median CHA2DS2-VASc score (4 [range: 3-5] vs. 3 [range: 2-4]; p<0.001), but similar HAS-BLED score (2 [range: 1-2] vs. 2 [range: 1-2]; p=0.141) when compared with men. Anticoagulant therapy use was higher in women (74.5% vs. 69.9%; p<0.001). Analysis of anticoagulation therapy use revealed that 68.5% of men and 61.6% of women (p=0.204) who had low risk for stroke (CHA2DS2-VASc score: 0 [male], 1 [female]) received anticoagulation therapy, and 30.5% of the men. Meanwhile, 25.3% of the women (p<0.001) with high risk for stroke (CHA2DS2-VASc score: ≥1 [male], ≥2 [female]) had not received any anticogulant therapy. Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.

Differences Between Women and Men in Phase I Cardiac Rehabilitation After Acute Myocardial Infarction: A Nationwide Population-Based Analysis.

Although numerous studies have investigated gender-related differences in patients who have had an acute myocardial infarction (AMI), few studies have examined the gender-related differences among inpatients receiving Phase I inpatient cardiac rehabilitation following AMI.Using data from the Taiwan National Health Insurance Research Database, this study analyzed 6713 adult patients who received inpatient cardiac rehabilitation following AMI between 2002 and 2011. The differences in comorbidity, medical service use, and prognosis between the male and female patients were analyzed to determine whether the comorbidities affecting their prognoses differed.Female patients accounted for 23.18% of the sample, had a higher average age, and exhibited severe comorbidities; furthermore, they had significantly more days of hospitalization and days in an intensive care unit than did male patients. The gender-related differences in hospital mortality rate and 30-day mortality rate were nonsignificant, but female patients exhibited a significantly higher 1-year mortality rate. Moreover, the risk for 1-year mortality was higher among female patients with moderate or severe renal disease (odds ratio: 1.94, 95% confidence interval: 1.29–2.92) than among their male counterparts. However, the 1-year mortality rate for the female patients did not increase after all risk factors were adjusted.Gender-related differences in age, comorbidity, and prognosis were confirmed in AMI patients receiving Phase I inpatient cardiac rehabilitation. In addition, gender-related differences were observed in the comorbidity risk factors affecting prognosis. However, being female did not affect the prognosis.

GW26-e2165 Gender-Related Differences in Patients with Acute Aortic Dissection From Xin Jiang

GW26-e2165 Gender-Related Differences in Patients with Acute Aortic Dissection From Xin Jiang

Gender-related differences in patients with ST-elevation myocardial infarction.

A decade ago women with ST-elevation myocardial infarction (STEMI) were significantly older than men, with more comorbidities, less likely treated by primary percutaneous coronary intervention (PPCI) and their prognosis was worse. The progress in treatment led to increased survival after STEMI. Our aim was to evaluate the possible current differences between the genders in treatments, mortality and the changes in women over time in STEMI population. We retrospectively evaluated 307 STEMI patients (224 men, 83 women), admitted between October 1, 2011 and December 31, 2012 and a historic group of 523 STEMI patients from 2008 to 2009 (361 men, 162 women). Reperfusion strategy was PPCI, combined with aspirin and clopidogrel or prasugrel or ticagrelor and a heparin with glycoprotein receptor IIb/IIIa antagonist or bivalirudin. Between the genders and in women over time we compared clinical data, the use and time to PPCI, in-hospital complications, 30-day and 6-month mortality. STEMI patients in recent years were treated by PPCI in 94.5 %. Their 30-day mortality was 10.4 % and 6-month mortality 14.7 %. Between the genders we observed mostly nonsignificant differences (age, comorbidities, treatments, in-hospital complications, 30-day and 6-month mortality). Over the last years in women mean age significantly decreased, the use of PPCI significantly increased, the incidence of heart failure and bleedings decreased significantly, but mortalities nonsignificantly. Women still account for 1/4 of STEMI population, but the gap between the genders in presentation, treatments and outcome in STEMI population is decreasing.

Unexplained syncope: implications of age and gender on patient characteristics and evaluation, the diagnostic yield of an implantable loop recorder, and the subsequent treatment.

BackgroundSyncope is a common clinical problem with a variety of underlying mechanisms, some of which occur more frequently in 1 of the sexes or at a certain age.HypothesisThere may be clinically significant age‐ and gender‐related differences in patients with unexplained syncope.MethodsFive hundred seventy patients (54% women) with unexplained syncope received an implantable loop recorder (ILR) and were followed until diagnosis or for at least 1 year.ResultsWomen were older and more prone to severe trauma during syncope (40.8% vs 29.9%, P = 0.007), and hospitalization was more common at ≥65 years (P = 0.003) without gender difference. Muscle spasms or grand mal seizures were more common in men and at <65 years old. Carotid sinus pressure, exercise testing, coronary angiography and magnetic resonance imaging/computed tomography scans were more commonly performed in men, whereas no test was more common in women. Tilt testing, exercise test, electroencephalography, and neurological or psychiatric evaluation were more common at ≥65 years. There were no age‐ or gender‐related differences in the diagnostic yield of the ILR, whereas patients ≥65 years old more often received specific treatment based on ILR data.ConclusionsGender and/or age had relevance for the clinical evaluation, rate of recurrence, and subsequent specific treatment but not for the diagnostic yield of the ILR.

Gender-related differences in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is an inflammatory arthritis that affects up to 30% of patients with psoriasis. Gender-related differences have been extensively investigated in spondyloarthritis, particularly in ankylosing spondylitis, which shares several genetic and clinical characteristics with PsA. PsA affects men and women equally. Sex may play a role in the underlying genetic mechanisms of PsA. The inheritance of psoriasis and PsA may be implicated by genomic imprinting, which is a differential expression of a gene depending on the sex of the transmitting parent. Gender-related differences are observed in the clinical expression of PsA. Males are more likely to develop axial involvement, while women tend to present with peripheral polyarticular disease. Men also develop more severe radiographic damage in their spine, as well as in their peripheral joints. Women tend to discontinue treatment with anti-TNF-α agents earlier than men owing to inferior response and more side effects. Women with PsA also tend t...

Gender-related differences in patients with acute heart failure: Management and predictors of in-hospital mortality

Aim and methodsGender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia. ResultsWomen accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p<0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p<0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p<0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42±15% vs 36±13%, p<0.001) and systolic blood pressure (135±40mmHg vs 131±39mmHg, p=0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p<0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p=0.475), and its common predictors were: systolic blood pressure at admission, creatinine>1.5mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men. ConclusionAmong patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders.

Gender-related differences in patients with Graves' disease

Objective To investigate the gender-related differences in patients with Graves'disease (GD).Methods Seven hundred and eighty-seven consecutive patients with GD treated with anti-thyroid drug in out-patient clinic of department of endocrinology of Chinese PLA general hospital from Oct.2009 to May 2010 were included in the study.The diagnosis of GD WSB made according to common clinical and laboratory criteria.Results (1)In Graves'disease,a marked female preponderance Was found.The female/male ratio was 3.35:1.Female patients with GD presented at a younger age,compared with males[(33.20±13.07 vs 36.75±13.89)year,P=0.002],and the peak incidences of the disease occurred in female and male were 20-29 years and 40-49 years of age respectively.(2)Male patients presented a higher prevalence of weight loss,thyrotoxic cardiopathy,periodic paralysis,and non-invasive ophthalmopathy whereas tachycardia was more common in females.(3)The females presented larger diffuse goiters with higher serum TT4,FT4,and thyrotropin receptor antibody(TRAb)levels.Cases with TRAb>30 U/L were more common in females,whereas those with TRAb 10-30 U/L were frequently seen in males.(4)There was no gender-related difference in the family history of GD.(5)Remission atleast 6 months after anti-thyroid drug therapy in 211 patients,there was a relapse rate of 64.3%(137/211)without gender difference.Conclusion GD appeared at a younger age and with larger diffuse goiters in females,together with more marked elevation of serum TT4,FT4 and TRAb levels.Altogether,these findings depict different patterns for GD in males and females. Key words: Graves'disease; Clinical features; Gender; Prognosis

Gender-Related Differences in Patients Who Underwent Catheter Ablation of Atrial Fibrillation

Gender-Related Differences in Patients Who Underwent Catheter Ablation of Atrial Fibrillation

Gender-related Differences in Patients With Stage I to III Upper Tract Urothelial Carcinoma: Results From the Surveillance, Epidemiology, and End Results Database

To examine the effect of gender in upper tract urothelial carcinoma (UTUC) stage at nephroureterectomy (NU), as well as on cancer-specific mortality (CSM) after NU in patients with American Joint Committee on Cancer stages I-III UTUC. Our analyses relied on 2903 (59.9%) males and 1947 (40.1%) females who underwent an NU for pT(1-3)N(0/x)M(0) UTUC between 1988 and 2006, within 17 Surveillance, Epidemiology, and End Results registries. Univariable and multivariable logistic regression models examined the effect of gender on stage and grade distribution at NU. Subsequently, cumulative incidence plots explored the impact of gender on CSM rates, after accounting for other-cause mortality (OCM). Finally, competing-risks regression models tested the independent predictor status of gender in CSM analyses. Covariates consisted of pT stage, pN stage, tumor grade, primary tumor location, type and year of surgery, age, and race. Relative to males, females had a higher proportion of pT(3) UTUC (43.1% vs 39%; P = .02) and a higher proportion of grade III/IV UTUC (63.8% vs 59.8%; P = .04) at NU. The female gender represented an independent predictor of pT(3) UTUC at NU (hazard ratio [HR]: 1.15; P = .03). After accounting for OCM, CSM rates in females were higher than those in males (HR: 1.18; P = .03). However, in multivariable competing-risks regression models, no statistically significant differences in survival were recorded between males and females (HR: 1.07; P = .4). Females are more likely to have more advanced pathologic T stage and higher tumor grade at NU than males. After accounting for OCM, stage, grade, and noncancer characteristics, gender no longer affects CSM.

Gender differences in patient and caregiver psychoeducation for schizophrenia

Objective The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation. Methods Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge. Results The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers. Conclusion Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.

Comorbidity and gender-related differences in patients hospitalized for COPD. The ECCO study

Patients hospitalized for a COPD exacerbation are usually of advanced age, with functional deterioration, and suffering an increased number of associated conditions, but little is known about gender differences. Our hypothesis is that the frequency and type of comorbidities differ in male and female COPD patients. A cross-sectional, multicentre study of patients hospitalized for a COPD exacerbation. All of them had COPD confirmed by baseline forced spirometry with a bronchodilator test. Comorbidity information was collected using the Charlson index, and an ad hoc questionnaire that included other common conditions not included in the Charlson index. We studied 398 patients, 353 men (89%) and 45 women (11%), with a mean (S.D.) age of 73.7 (8.9) years and a percent predicted FEV(1) of 43.2 (12.5). The mean score of the Charlson index was 2.7 (2.0), with no differences by gender; in contrast, the mean number of all comorbid conditions assessed was 3.7 (1.7) in men and 1.8 (1.8) in women (p < 0.05). Overall, 55% of the patients had arterial hypertension, 26% diabetes mellitus, 27% chronic heart failure, and 17% ischemic heart disease. Female COPD patients had a lower prevalence of ischemic heart disease (p = 0.008) and alcoholism (p = 0.03), but presented more frequently with chronic heart failure (p = 0.03), osteoporosis (p = 0.007) and diabetes mellitus without complications (p = 0.02). Comorbidities are common in patients hospitalized for a COPD exacerbation, but their relative distribution varies by gender. The exclusive use of the Charlson index underestimates comorbidities in COPD patients.

Lack of major gender-related differences in patients undergoing elective endovascular or surgical repair of abdominal aortic aneurysm.

The aim of this single center retrospective study was to determine gender-related differences in patients undergoing repair of aortic aneurysm. A total of 296 consecutive patients with an abdominal aneurysm undergoing elective endovascular or surgical repair was included in the study. Among these, 24 (8.1%) were females and 272 (91.9%) were males. Demographic and clinical characteristics as well as laboratory values in terms of any potential gender-specific differences were compared. Females were significantly older at the time of repair than males. No gender-related differences were found analysing major clinical and laboratory parameters. The clinical and laboratory profile with which males and females present at the time of elective endovascular or surgical repair for aortic aneurysm is very similar. It does not reveal any potential gender-specific risk constellation. It eventually remains unclear why the prevalence of aortic aneurysm is higher in male than in females.

Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II

This analysis evaluates the gender differences in patients hospitalised for acute heart failure (AHF) in the EuroHeart Failure Survey II (EHFS). Of the 3580 patients included in EHFS II, 1384 (39%) were women, mean age 73 years. 2196 (61%) were men, mean age 68 years. Women more frequently had new-onset AHF, hypertension and valvular disease and less frequently coronary heart disease or dilated cardiomyopathy compared with men. Smoking, chronic obstructive pulmonary disease, peripheral arterial disease and renal failure were less common, but diabetes and anaemia significantly more frequent in women. Atrial fibrillation and preserved left ventricular function were more common in women. Men were more often non-compliant with medication. After adjustment for indications and age, there were no significant gender differences in prescription of HF medication. All-cause readmission rate during the one-year follow-up was lower in women. However, the proportion of HF hospitalisation and one-year mortality after discharge (20%) were similar in both genders. Women frequently present with new-onset AHF. A significant gender difference exists in aetiology, ventricular function and co-morbidities. Women's use of HF medication has improved. These findings emphasize the importance of individualised management and need for more comprehensive recruitment of women in clinical trials.

Gender-Related Differences in Patients Admitted with Acute Decompensated Heart Failure

Background: Gender-related differences in patients (pts) with acute decompensated heart failure (ADHF)) have not been well described. Objectives: To report gender-related differences regarding baseline characteristics and outcomes in pts admitted with ADHF. Methods: From June 2006 through January 2007 71 pts with ADHF from 3 hospitals were included. Mean age was 73 ± 12.6 years and mean LV ejection fraction was 43 ± 14%. We assessed gender-related differences regarding baseline characteristics and outcomes. Results: There were 47 (66%) men. Mean age did not differ between the groups (73 ± 13 vs 74.5 ± 12, p = 0.72). A history of heart failure was more frequent in men (78.7% vs 50%, p = 0.01). Women had higher prevalence of heart failure with preserved systolic function (39% vs 10.8%, p = 0.02) and higher B-type natriuretic peptide (BNP) values (median 791 [interquartil range 491-1112] vs 486 [277-654] pg/mL, p = 0.001). Hospital length of stay was higher in men (median 10 [6-20] vs 5 [4-10] days, p = 0.04). There was a trend for higher mortality rate in men (8.5% vs 0%, p = 0.29). Conclusion: In pts admitted for ADHF the presence of preserved systolic function is higher in women. Although women present with higher BNP levels than men their outcomes seem to be better, suggesting either a better response to treatment or a gender-related baseline difference regarding the values of BNP which is independent of HF severity.

Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe: A Report From the Euro Heart Survey on Atrial Fibrillation

This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. Gender-related differences may play a significant role in AF. We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019). Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar.

Gender-related differences in dyspepsia: A qualitative systematic review

Relative to men, women are diagnosed more frequently with functional gastrointestinal (GI) disorders. With increased awareness of basic gender differences in perception and treatment of visceral pain, there has been new interest in research on gender disparity in the care of people with functional GI disorders. Past attention has focused on irritable bowel syndrome, whereas gender differences in other disorders are less well described. Our aim was to systematically review studies that have examined gender-related differences among patients with dyspepsia. MEDLINE, HealthSTAR, and PsycINFO databases were searched for English-language articles on dyspepsia published between 1966 and August 2001. Epidemiologic studies, clinical trials, review articles, and conceptual articles from peer-reviewed journals were included for review. Findings were summarized and discussed within a framework of biological and psychosocial factors. Statistical analysis of combined data was inappropriate because of the inconsistent definition of dyspepsia among different studies and wide variation in the types of articles reviewed. Studies that examine gender-related differences in patients with dyspepsia have focused their investigations on the clinical epidemiology and pathophysiology of dyspepsia. In most epidemiologic studies, no gender analysis was performed beyond a description of sample demographics, and when statistical significance was tested, few consistent gender differences were found. Overall, it appears that men and women with dyspepsia possibly differ with respect to pattern of symptoms, pain perception or modulation, and antinociceptive mechanisms, but these observations have not been confirmed. No study evaluated the clinical implications of these possible differences. Future efforts should be directed to not only examine gender-related differences in the clinical epidemiology of dyspepsia, but also understand their clinical significance. Therefore, well-designed population-based studies using a consistent definition of dyspepsia are needed to investigate the prevalence of dyspepsia symptoms and patterns of dyspepsia management among men and women.

Gender related differences in patients with type 2 diabetes with or without autoantibodies to glutamic acid decarboxilase (GAD)

Gender related differences in patients with type 2 diabetes with or without autoantibodies to glutamic acid decarboxilase (GAD)

376 Gender-related differences in patients with atrioventricular nodal reentry tachycardia

376 Gender-related differences in patients with atrioventricular nodal reentry tachycardia

Surgery

Surgery