Uticaj pola i godina starosti bolesnika na kvalitet lečenja, morbiditet i mortalitet u srčanoj insuficijenciji
Sex and age-related differences in the quality of treatment, morbidity and mortality in heart failure patients
Author
Milinković, IvanMentor
Seferović, PetarCommittee members
Ristić, Arsen D.Simić, Dragan
Davidović, Goran
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Show full item recordAbstract
Cilj rada: Procena razlika u lečenju, jednogodišnjem mortalitetu i hospitalizacijama bolesnika sa hroničnom srčanom insuficijencijom prema polu i godinama starosti.
Metode i rezultati: Od 16,354 bolesnika koji su uključeni u Registar bolesnika sa srčanom insuficijencijom Evropskog udruženja za srčanu slabost (European Society of Cardiology Heart Failure Long-Term Registry), analizirano je 9,428 bolesnika sa hroničnom srčanom insuficijencijom srednje starosti 66 godina, od toga 28.5% žena, srednje ejekcione frakcije leve komore (EFLK) oko 37%. Primena medikamentne terapije za srčanu insuficijencijum u skladu sa preporukama (eng. guideline-directed medical therapy-GDMT) je bila visoka (inhibitora angiotenzin konvertujućeg enzima ili blokatora angiotenzinskih receptora kod 85.7%, beta blokatora u 88.7% i antagonista mineralokortikoidnih receptora kod 58.8% bolesnika sa srčanom insuficijencijom). Primena GDMT je bila manja kod žena u poređenju sa muškarcima (p≤0.001 za sve lekove), a prime...na GDMT sa smanjivala sa godinama starost kod oba pola, kako na početku, tako i nakon jedne godine praćenja. Pol nije bio nezavisan prediktor propisivanja GDMT, ali je starost > 75 godina bila značajan prediktor za manju primenu GDMT. U poređenju sa muškarcima, žene su imale manji ukupni mortalitet (žene 7.1%; muškarci 8.7%, p=0.015) i ukupne hospitalizacije (žene 21.9%; muškarci 27.3%, p˂0.001), ali nije bilo razlike u uzrocima mortaliteta. Ukupan mortalitet i ukupne hospitalizacije su se povećavale sa starošću bolesnka kod oba pola. Pol nije bio nezavisan prediktor jednogodišnjeg mortaliteta u populaciju sa EFLK ≤45%. Rizik od mortaliteta je bio značajno manji kod mlađih bolesnika u poređenju sa grupom starijom od >75 godina.
Zaključci. Sa starenjem se smanjuje primena GDMT kod oba pola. Pol nije nezavisan prediktor primenene GDMT ili neželjenih ishoda kod bolesnika sa srčanom insuficijencijom. Međutim, starost >75 godina je nezavisan prediktor manje primene GDMT i većeg ukupnog mortaliteta kod bolesnika sa EFLK ≤45%.
Aim: To assess sex and age-related differences in the management, and 1-year risk of all-cause mortality and hospitalization in chronic heart failure (HF) patients.
Methods and results: Of 16,354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analyzed (median age 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF), 37%). Use of guideline-directed medical therapy (GDMT) was high (angiotensin-converting enzyme inhibitors / angiotensin receptor blockers, beta blockers, and mineralocorticoid receptor antagonists, 85.7%, 88.7% and 58.8% respectively). Crude GDMT utilization rates were lower in women compared with men (p for all ≤0.001), and GDMT use was lower with aging in both sexes, at baseline and 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age > 75 years was a significant predictor GDMT underutilization. Compared with men, women had lower rates of all-caus...e mortality (7.1% vs 8.7%, p=0.015) and all-cause hospitalization (21.9% vs 27.3%, p˂0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with increasing age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients >75 years.
Conclusions. There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and a higher all-cause mortality in patients with LVEF ≤45%.
Faculty:
Универзитет у Београду, Медицински факултетDate:
28-09-2020Projects:
- Diastolic heart failure in cardiomyopathies, diabetes, pericardial diseases, and pulmonary hypertension: diagnostic criteria, risk stratification and therapeutic modalities (RS-MESTD-Basic Research (BR or ON)-175080)