Navigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinations

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dc.authoridSahin, Anil/0000-0003-3416-5965
dc.authoridCelik, Ahmet/0000-0002-9417-7610
dc.authoridYILMAZ, MEHMET BIRHAN/0000-0002-8169-8628
dc.contributor.authorCelik, Ahmet
dc.contributor.authorSahin, Anil
dc.contributor.authorAta, Naim
dc.contributor.authorColluoglu, Inci Tugce
dc.contributor.authorUral, Dilek
dc.contributor.authorKanik, Emine Arzu
dc.contributor.authorAyvali, Mustafa Okan
dc.date.accessioned2024-09-29T15:54:55Z
dc.date.available2024-09-29T15:54:55Z
dc.date.issued2024
dc.departmentKarabük Üniversitesien_US
dc.description.abstractMajor heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the underrepresentation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, b blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and b blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on allcause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations. (c) 2024 Elsevier Inc. All rights reserved. (Am J Cardiol 2024;216:27-34)en_US
dc.identifier.doi10.1016/j.amjcard.2024.01.017
dc.identifier.endpage34en_US
dc.identifier.issn0002-9149
dc.identifier.issn1879-1913
dc.identifier.pmid38266795en_US
dc.identifier.scopus2-s2.0-85185595423en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage27en_US
dc.identifier.urihttps://doi.org/10.1016/j.amjcard.2024.01.017
dc.identifier.urihttps://hdl.handle.net/20.500.14619/4363
dc.identifier.volume216en_US
dc.identifier.wosWOS:001197405000001en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherExcerpta Medica Inc-Elsevier Science Incen_US
dc.relation.ispartofAmerican Journal of Cardiologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectAll-cause mortalityen_US
dc.subjectevidence-based treatmenten_US
dc.subjectheart failureen_US
dc.subjectpersonalized manage- menten_US
dc.subjectsex disparitiesen_US
dc.titleNavigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinationsen_US
dc.typeArticleen_US

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