Comprehensive vasodilatation in women with acute heart failure: Novel insights from the GALACTIC randomized controlled trial

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Citações na Scopus
1
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Dimensions
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
WUSSLER, Desiree
BELKIN, Maria
MAEDER, Micha T.
WALTER, Joan
SHRESTHA, Samyut
KUPSKA, Karolina
STIERLI, Michelle
FLORES, Dayana
KOZHUHAROV, Nikola
Citação
EUROPEAN JOURNAL OF HEART FAILURE, v.25, n.12, p.2218-2229, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Aims Sex-specific differences in acute heart failure (AHF) are both relevant and underappreciated. Therefore, it is crucial to evaluate the risk/benefit ratio and the implementation of novel AHF therapies in women and men separately.Methods and results We performed a pre-defined sex-specific analysis in AHF patients randomized to a strategy of early intensive and sustained vasodilatation versus usual care in an international, multicentre, open-label, blinded endpoint trial. Inclusion criteria were AHF with increased plasma concentrations of natriuretic peptides, systolic blood pressure >= 100 mmHg, and plan for treatment in a general ward. Among 781 eligible patients, 288 (37%) were women. Women were older (median 83 vs. 76 years), had a lower body weight (median 64.5 vs. 77.6 kg) and lower estimated glomerular filtration rate (median 48 vs. 54 ml/min/1.73 m(2)). The primary endpoint, a composite of all-cause mortality or rehospitalization for AHF at 180 days, showed a significant interaction of treatment strategy and sex (p for interaction = 0.03; hazard ratio adjusted for female sex 1.62, 95% confidence interval 1.05-2.50; p = 0.03). The combined endpoint occurred in 53 women (38%) in the intervention group and in 35 (24%) in the usual care group. The implementation of rapid up-titration of renin-angiotensin-aldosterone system (RAAS) inhibitors was less successful in women versus men in the overall cohort and in patients with heart failure with reduced ejection fraction (median discharge % target dose in patients randomized to intervention: 50% in women vs. 75% in men).Conclusion Rapid up-titration of RAAS inhibitors was less successfully implemented in women possibly explaining their higher rate of all-cause mortality and rehospitalization for AHF.
Palavras-chave
Sex differences, Acute heart failure, Pharmacotherapy, Sex-specific therapy approach
URI
https://observatorio.fm.usp.br/handle/OPI/59287
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Coleções
Artigos e Materiais de Revistas Científicas - HC/InCor