Impact of sex on heart failure pharmacotherapy and outcomes in patients with ischaemic heart disease and comorbid heart failure with reduced ejection fraction.

Abstract

Background/Aims: In clinical practice, women are less often on guideline-directed medical therapy. We aimed to investigate if a sex discrepancy exists for optimal medical therapy (OMT) and long-term mortality in patients with known ischaemic heart disease (IHD) and comorbid heart failure with reduced ejection fraction (HFrEF). Methods: We analysed data on pharmacotherapy 30 days post-percutaneous coronary intervention from a prospectively collected multicentre registry in patients with IHD and pre-existing or newly diagnosed HFrEF between 2005-2018. OMT was defined as beta-blocker (BB), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB)±mineralocorticoid receptor antagonist (MRA). Long-term mortality was obtained via linkage with the National Death Index. Results: Women accounted for 24% (372/1,567), and were on average 3-years older (71±12 vs 68±11 years) than men. Women had higher rates of hypertension, renal dysfunction and rheumatoid arthritis. Overall, 74% (1,160) of patients were on OMT, with similar rates between sexes (76.6% vs 73.2%, p=0.19). Women were more likely to be on a BB (89.3% vs 84.9%, p=0.04), while rates of ACEi/ARB (78.2% vs 80.8%, p=0.29) and MRA (26.3% vs 29.4%, p=0.27) were similar between sexes. At 30 days, rates of arrhythmia (p<0.001) and recurrent myocardial infarction (p=0.003) were higher amongst women. Mortality was higher for both sexes on sub-optimal medical therapy (SMT), however, there was no difference in long-term mortality (median 3.7 years) between sexes (figure). Conclusion: Amongst patients with IHD and comorbid HFrEF, women had similar rates of OMT and similar long-term mortality compared to men.