Sex differences in pharmacotherapy and long-term outcomes in patients with ischaemic heart disease and left ventricular dysfunction.

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.