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Author: search.filters.author.Bugiardini, RaffaeleSubject: search.filters.subject.acute heart failure

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    Item type:Publication,
    Sex Differences in Heart Failure Following Acute Coronary Syndromes
    (Elsevier BV, 2023-05)
    Cenko, Edina
    ;
    Manfrini, Olivia
    ;
    Yoon, Jinsung
    ;
    van der Schaar, Mihaela
    ;
    Bergami, Maria
    BACKGROUND There have been conflicting reports regarding outcomes in women presenting with acute coronary syndrome (ACS).OBJECTIVES The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation.METHODS This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes (ISACS Archives-NCT04008173). Acute HF was defined as Killip classes $2. Participants were stratified according to ACSpresentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale. RESULTS A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio (RR): 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR:1.18; 95% CI: 1.09-1.28; P interaction < 0.001). Acute HF was more common in women when compared to men with STEMI(RR: 1.24; 95% CI: 1.20-1.29) but not in those with NSTE-ACS (RR: 1.02; 95% CI: 0.97-1.08) (P interaction < 0.001). The presence of acute HF increased the risk of mortality for both sexes (odds ratio: 6.60; 95% CI: 6.25-6.98).CONCLUSIONS In patients presenting with ACS, mortality is higher in women. The presence of acute HF at hospital presentation increases the risk of mortality in both sexes. Women with STEMI are more likely to present with acute HFand this may, in part, explain sex differences in mortality. These findings may be helpful to improve sex-specific personalized risk stratification. (JACC Adv 2023;-:100294) © 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open-access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) (14) (PDF) Sex Differences in Heart Failure Following Acute Coronary Syndromes. Available from: https://www.researchgate.net/publication/370306869_Sex_Differences_in_Heart_Failure_Following_Acute_Coronary_Syndromes [accessed Jun 23, 2023].
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    Item type:Publication,
    Sex differences and disparities in cardiovascular outcomes of COVID-19
    (Oxford University Press (OUP), 2023-01-18)
    Bugiardini, Raffaele
    ;
    Nava, Stefano
    ;
    Caramori, Gaetano
    ;
    Yoon, Jinsung
    ;
    Badimon, Lina
    Background Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods and Results This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19(NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios(RR) of in-hospital mortality, acute respiratory failure(ARF), acute heart failure(AHF), and acute kidney injury(AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models. The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524(33.9%) were admitted to ICU, and 1,117(24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR:0.80; 95%CI: 0.71–0.91). In general wards (GW) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13(95%CI: 0.90–1.42) and 0.86(95%CI: 0.70–1.05; pinteraction=0.04). Development of AHF, AKI and ARF was associated with increased mortality risk (ORs: 2.27; 95%CI; 1.73–2.98,3.85; 95%CI:3.21–4.63 and 3.95; 95%CI:3.04–5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs:1.25; 95%CI0.94–1.67 versus 0.83; 95%CI:0.59–1.16, pinteraction=0.04). Conclusions Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.