Article

ASEAN Heart Journal

, 22:8

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

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

  • Peter ChangAffiliated withNational University Health System, Cardiac Department
  • , Shaw Yang ChiaAffiliated withNational Heart Centre Singapore, Department of Cardiology
  • , Ling Ling SimAffiliated withNational Heart Centre Singapore, Department of Cardiology
  • , Fei GaoAffiliated withNational Heart Centre Singapore, Department of Cardiology
  • , Fong Ling LeeAffiliated withKhoo Teck Puat Hospital, Department of Cardiology
  • , Ping ChaiAffiliated withNational University Health System, Cardiac Department
  • , Raymond Ching-Chiew WongAffiliated withNational University Health System, Cardiac Department
  • , Swee Chong SeowAffiliated withNational University Health System, Cardiac Department
  • , Gerard Kui Toh LeongAffiliated withChangi General Hospital, Department of Cardiology
    • , Poh Shuan Daniel YeoAffiliated withTan Tock Seng Hospital, Department of CardiologySingapore Cardiac Data Bank, Apex Heart Clinic, Gleneagles Hospital, Singapore
    • , David SimAffiliated withNational Heart Centre Singapore, Department of Cardiology
    • , Terrance ChuaAffiliated withNational Heart Centre Singapore, Department of Cardiology
    • , Bernard W.K. KwokAffiliated withNational Heart Centre Singapore, Department of Cardiology
    • , Carolyn S.P. LamAffiliated withNational University Health System, Cardiac Department Email author 

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.

Key words:

Congestive heart failure Sex Characteristics Treatment