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Title: Sex differences in pharmacotherapy and long-term outcomes in patients with ischaemic heart disease and left ventricular dysfunction.
Author: Dagan, M.
Dinh, D.
Stehli, J.
Tan, C.
Brennan, A.
Ajani, A.
Oqueli, Ernesto
Kaye, D.
Freeman, M.
Reid, C.
Hiew, C.
Clark, D.
Duffy, S.
Issue Date: 2020
Conference Name: 68th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 14th Annual Australia and New Zealand Endovascular Therapies Meeting
Conference Date: December 11-13
Conference Place: Online
Abstract: Background: Left ventricular dysfunction and ischaemic heart disease (IHD) are common amongst women, however, women tend to present later and are less likely to receive guideline-directed medical therapy compared to men. Methods: We analysed prospectively collected data (2005-2018) from a multicentre registry on optimal medical therapy (OMT) 30-days post-percutaneous coronary intervention in 13,015 patients with left ventricular ejection fraction <50%. OMT was defined as beta-blocker (BB), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB)┬▒mineralocorticoid receptor antagonist (MRA). Long-term mortality was determined by linkage with the National Death Index. Results: Mean age was 65┬▒12 years; women represented 20% (2,634) of the cohort. Women were on average 5-years older, with higher BMI, higher rates of hypertension, diabetes, renal dysfunction, prior stroke and rheumatoid arthritis. OMT was similar between sexes (72.7% vs 72.2%, p=0.58). BB therapy was also similar between sexes (85.2% vs 84.5%, p=0.38), while women were less likely to be on an ACEi/ARB (80.4% vs 82.4%, p=0.02) and more likely to be on a MRA (12.1% vs 10.0%, p=0.003). 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), though not on multivariable analysis (HR 0.99, 95% CI 0.87-1.14, p=0.94). Conclusion: Rates of OMT for left ventricular dysfunction were similar between sexes, however women were less likely to be on appropriate IHD secondary prevention. The increased unadjusted long-term mortality amongst women is likely due to differing baseline risk, given that adjusted mortality was similar between sexes.
Internal ID Number: 01642
Type: Conference
Appears in Collections:Research Output

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