ARE WOMEN WITH CHRONIC HEART FAILURE NEGLECTED?

Background:There are significant epidemiological,clinical,treatment and prognostic differences between women and men with heart failure (HF). Patients and methods: 282 consecutive pts (m:164, f:118) with systolic HF (ejection fraction≤45%),from Jan`05 to Aug`07. We retrospectively compared clinical characteristics,treatment and in-hospital mortality between women and men.After exclusion of 58 pts with valvular etiology and terminal illness we analysed standard and „new“ quality markers (QM) for ACE-inhibitors (ACEi) and beta-blockers (BB):1. new QM: a) appropriate use (BB use;pts with drug including pts without drug because of objective reasons, b) appropriate dose (BB dose;pts with target dose and with lower dose due to objective reasons); 2.standard QM: a) prescription rate(BB Rx;pts with drug),b) target dose rate (BB target;pts with drug in target dose). Results:Women were significantly(p<0.001) older (84±11vs.75±9 yrs),more often hypertensive (87vs.75%)and diabetics(52vs.34%),have higher EF(40vs.31%),more advanced HF(NYHA III-IV,67 vs.54%),lower prevalence of ischemic etiology(68vs.77%) and atrial fibrilation(15vs.24%).Digoxin was used significantly more frequently in women(47vs.35%,p<0.01),but in lower dose(0,125 mg in 88% of women,75% in men).There were no gender-differences in QM for ACEi, but men were significantly (p<0.05) more likely to be receiving BB (BB Rx:78 vs 69%) and target dose of BB (BB target:31 vs 23%). Neverthless BB use and BB dose were similar (99 vs 97%, resp. 92 vs 90%, ns). ACEi-induced cough was more frequent in women (9 vs 4%, ns). In contrast with previous reports in-hospital mortality was higher in women than men, even after adjustment for age, etiology and NYHA class (13 vs 5%, p=0,051, with borderline statistical significance).Conclusions:There is urgent need for further research specifically focused on women with HF.