Abstract 4065: Concrete Symptom Clusters are Identifiable and Identical in Women and Men with Heart Failure, and Predict Health Outcome

Background: Although symptoms in patients (pts) with heart failure (HF) are often viewed in isolation, pts usually have multiple, concurrent symptoms. Identification of symptom clusters could improve pts’ recognition of worsening HF, and enhance pt care. Given gender differences in outcomes in HF, examination of potential differences in clusters and their impact on outcomes is reasonable. Purpose: To identify HF symptom clusters in women and men and examine the impact of clusters on total number of all-cause hospitalizations per pt during 12 month follow-up. Methods: Data from 513 pts with HF (61 ± 12 yrs, 31.7% female, 53.6% NYHA III/IV) were used. Seven symptoms (i.e., edema, dyspnea, fatigue, trouble sleeping, worry, depression, and memory problems) were analyzed for clustering using an agglomerative hierarchical clustering approach and Ward’s method. Validity of cluster solution was assessed with split-sample replication. Symptoms were clustered, and pts were grouped based on symptom burden in clusters. Results: Two symptom clusters were identified in both men and women: physical symptom cluster - dyspnea, fatigue, trouble sleeping; and emotional/cognitive symptom cluster - worry, memory problems, depression. Pts were grouped into 4 based on their symptom burden in each of the 2 clusters: low burden related to both clusters; burden from physical cluster > than that from emotional cluster; burden from the emotional cluster > than that from physical cluster; and high and equal burden from both clusters. ANOVA revealed a difference in number of hospitalizations in both men and women based on the groups (p=.002); there were no gender differences. Pts in group 3 (emotional symptoms > than physical) were most frequently hospitalized (1.8 ± 2.8 hospitalizations/pt in group 3 compared to 1.7 ± 2.5/pt in group 4 vs .88 ± 1.6/pt in group 2 vs .66 ± 1.3/pt in group 1; post hoc Tukey indicates p <.05 for all comparisons except group 3 with 4). Conclusion: HF symptoms cluster in two identifiable groups: a physical and an emotional/cognitive cluster. Pts with the most burden from the emotional cluster have the worst outcomes, suggesting that increased attention needs to be paid by clinicians to emotional symptoms and the fact that they occur in clusters.

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Age and gender differences in physical heart failure symptom clusters

Heart & Lung ◽

10.1016/j.hrtlng.2021.07.001 ◽

2021 ◽

Vol 50 (6) ◽

pp. 832-837

Author(s):

Kristen A. Sethares ◽

Elizabeth Chin

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Symptom Clusters ◽

Age And Gender ◽

Heart Failure Symptom ◽

Age And Gender Differences ◽

And Gender

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Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis

Circulation ◽

10.1161/circ.138.suppl_1.17356 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Setri Fugar ◽

Juliet A Yirerong ◽

Alfred Solomon ◽

Ahmed A Kolkailah ◽

Tauseef Akthar ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Gender Differences ◽

Clinical Presentation ◽

Artery Dissection ◽

P Value ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Men And Women ◽

Significant Difference

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=<0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06) Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

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Abstract 14824: Identifying Gender Differences in Physical Frailty Phenotypes in Heart Failure: A Focus on Physiological, Clinical, and Symptom Characteristics

Circulation ◽

10.1161/circ.142.suppl_3.14824 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Quin E Denfeld ◽

Beth A HABECKER ◽

S. A Camacho ◽

Mary Davis ◽

Nandita Gupta ◽

...

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Pain Interference ◽

Depression And Anxiety ◽

Physical Frailty ◽

Frailty Phenotype ◽

Men And Women ◽

Comorbidity Burden ◽

Appendicular Muscle Mass

Introduction: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this gender difference are poorly understood. The purpose of this study was to characterize gender differences in physical frailty phenotypes in HF with a focus on physiological, clinical, and symptom characteristics. Methods: We prospectively enrolled adults with Class I-IV HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity; those who met 0-2 criteria were not physically frail, and those who met 3-5 criteria were physically frail. Body composition was measured using dual energy x-ray absorptiometry. Clinical data were extracted from the medical record. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Simple comparative statistics and multivariate logistic regression were used to identify gender differences in physical frailty. Results: The average age of the sample (n = 115) was 63.6±15.7 years, 49% were women, and 73% had non-ischemic etiology. About 43% of the sample was physically frail. Women were 4.5 times as likely to be physically frail compared with men, adjusting for covariates (OR = 4.52, 95%CI [1.69, 12.08], p = 0.003). Both physically frail men and women had significantly more type 2 diabetes and worse dyspnea symptoms compared with non-physically frail men and women, respectively. Physically frail men had significantly lower appendicular muscle mass, higher percent body fat, trunk fat, and appendicular fat, and lower hemoglobin compared with non-physically frail men (all p < 0.05). Physically frail women had significantly higher comorbidity burden and worse sleep-related impairment, pain interference, and depressive symptoms compared with non-physically frail women (all p < 0.05). Conclusions: Women are significantly more likely to be physically frail in HF. Physical frailty in men with HF may be primarily characterized by comorbidities and sarcopenic obesity; whereas physical frailty in women with HF may be predominantly characterized by comorbidities and worse symptoms.

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Symptom Clusters in Men and Women With Heart Failure and Their Impact on Cardiac Event-Free Survival

The Journal of Cardiovascular Nursing ◽

10.1097/jcn.0b013e3181cfbb88 ◽

2010 ◽

Vol 25 (4) ◽

pp. 263-272 ◽

Cited By ~ 52

Author(s):

Kyoung Suk Lee ◽

Eun Kyeung Song ◽

Terry A. Lennie ◽

Susan K. Frazier ◽

Misook L. Chung ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Event ◽

Symptom Clusters ◽

Event Free Survival ◽

Free Survival ◽

Men And Women

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Abstract 17620: Does Doppler E/e’ Ratio Reliably Estimate Diastolic Filling Pressures in Stress Cardiomyopathy?: A Validation Study in Apical and non-Apical Phenotypes

Circulation ◽

10.1161/circ.130.suppl_2.17620 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Aline Iskandar ◽

Gerard P Aurigemma ◽

Timothy P Fitzgibbons ◽

Mohammed Ahmed ◽

Dennis Tighe

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Diastolic Pressure ◽

Tissue Doppler ◽

Stress Cardiomyopathy ◽

Diastolic Filling ◽

List Type ◽

Individual Data ◽

Group 3 ◽

Invasive Measurement

BACKGROUND: We have recently shown that mean LV end diastolic pressure (LVEDP) is commonly elevated in apical ("Tako-tsubo") stress cardiomyopathy (SCM) and likely contributes to heart failure in this syndrome. The assessment of diastolic filling pressures by use of E/e’ ratio (early diastolic transmitral E to tissue Doppler e') has been applied to many forms of heart disease, but has not been validated in SCM, and has not been studied in the apical sparing variant. METHODS: We identified 62 patients with SCM, 43 patients with apical/Tako-tsubo SCM and 19 patients with apical sparing (basal and midventricular) variant of SCM, who underwent measurement of E/e', using the average of lateral and septal e’ (cm/s), within 48 hours of direct invasive measurement of LVEDP (mm Hg). RESULTS: LVEDP was significantly higher in apical sparing SCM compared to apical SCM (28 ± 6 mmHg vs. 22 ± 7 mmHg, p<0.002). LVEDP directly correlated with E/e’ ratio in apical SCM (r = 0.64, p < 0.0001, Figure 1). When individual data were examined, we found that of the apical SCM group, 3 pts had normal LVEDP and were correctly identified with normal E/e’ ratio (< 8). All apical SCM patients with elevated LVEDP (16 mm Hg or greater) had E/e’ > 8, and fifteen of these had E/e’ ratio > 15. By contrast, all apical sparing SCM had elevated LVEDP. In this group, E/e’ did not predict LVEDP: the overall correlation between E/e’ and LVEDP (r = 0.27, p = 0.26, Figure 2) was poor. When individual data were examined, 5 patients with elevated LVEDP had normal E/e’ and, of the remaining 14 patients with elevated LVEDP, only 1 patient had E/e’ >15. CONCLUSION: Our results demonstrate: 1. Elevated LVEDP is found among 95% of SCM, regardless of the phenotype. 2. Unexpectedly, apical sparing SCM appears to have worse impairment of diastolic function and higher LVEDP than apical variant SCM 3. E/e’ ratio reliably predicts LVEDP in pts with apical variant SCM; by contrast, this index underestimates LVEDP among patients with apical sparing SCM.

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Gender Differences in Patients with Heart Failure

European Journal of Cardiovascular Nursing ◽

10.1016/s1474-5151(03)00002-1 ◽

2003 ◽

Vol 2 (1) ◽

pp. 7-18 ◽

Cited By ~ 92

Author(s):

Anna Strömberg ◽

Jan Mårtensson

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Healthcare Utilisation ◽

Men And Women ◽

Daily Life Activities ◽

Patients With Heart Failure ◽

And Gender ◽

The Impact ◽

Support Family

Aim: The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. Method: Two primary health care resources, MEDLINE and CINAHL, were selected to review the current literature. In MEDLINE, 234 abstracts dealing with heart failure and gender/sex were found and in CINAHL, 20 abstracts. Conclusion: Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. The extent of sex differences in treatment, hospital cost and quality of care can partly be explained by age differences. The life situations for men and women with heart failure are different. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women. Women with heart failure ascribe more positive meanings to their illness. Despite this, women seem to experience a lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care.

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