Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34234
Title: Sex Differences in Pharmacotherapy and Long-Term Outcomes in Patients With Ischaemic Heart Disease and Comorbid Left Ventricular Dysfunction.
Austin Authors: Dagan, Misha;Dinh, Diem T;Stehli, Julia;Nan Tie, Emilia;Brennan, Angela;Ajani, Andrew E;Clark, David J ;Freeman, Melanie;Reid, Christopher M;Hiew, Chin;Oqueli, Ernesto;Kaye, David M;Duffy, Stephen J
Affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia.
Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia.
Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Department of Cardiology, Box Hill Hospital, Melbourne, Vic, Australia.
Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Population Health, Curtin University, Perth, WA, Australia.
Department of Cardiology, University Hospital Geelong, Geelong, Vic, Australia; School of Medicine, Deakin University, Melbourne, Vic, Australia.
Department of Cardiology, Ballarat Base Hospital, Melbourne, Vic, Australia.
Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Vic, Australia.
Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Vic, Australia.
Cardiology
Issue Date: Dec-2023
Date: 2023
Publication information: Heart, Lung & Circulation 2023-12; 32(12)
Abstract: Left ventricular (LV) dysfunction and ischaemic heart disease (IHD) are common among women. However, women tend to present later and are less likely to receive guideline-directed medical therapy (GDMT) compared with men. We analysed prospectively collected data (2005-2018) from a multicentre registry on GDMT 30 days after percutaneous coronary intervention in 13,015 patients with LV ejection fraction <50%. Guideline-directed medical therapy was defined as beta blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker±mineralocorticoid receptor antagonist. Long-term mortality was determined by linkage with the Australian National Death Index. Women represented 20% (2,634) of the total cohort. Mean age was 65±12 years. Women were on average >5 years, with higher body mass index and higher rates of hypertension, diabetes, renal dysfunction, prior stroke, and rheumatoid arthritis. Guideline-directed medical therapy was similar between sexes (73% vs 72%; p=0.58), although women were less likely to be on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (80% vs 82%; p=0.02). Women were less likely to be on statin therapy (p<0.001) or a second antiplatelet agent (p=0.007). Women had higher unadjusted long-term mortality (25% vs 19%; p<0.001); however, there were no differences in long-term mortality between sexes on adjusted analysis (hazard ratio 0.99; 95% confidence interval 0.87-1.14; p=0.94). Rates of GDMT for LV dysfunction were high and similar between sexes; however, women were less likely to be on appropriate IHD secondary prevention. The increased unadjusted long-term mortality in women was attenuated in adjusted analysis, which highlights the need for optimisation of baseline risk to improve long-term outcomes of women with IHD and comorbid LV dysfunction.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34234
DOI: 10.1016/j.hlc.2023.09.008
ORCID: 
Journal: Heart, Lung & Circulation
PubMed URL: 37945426
ISSN: 1444-2892
Type: Journal Article
Subjects: Optimal medical therapy
Pharmacotherapy
Secondary prevention
Sex differences
Women's heart disease
Appears in Collections:Journal articles

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