Sex differences in early dyspnea relief in the RELAX-AHF study
Sex differences in early dyspnea relief between men and women hospitalized for acute heart failure: insights from the RELAX-AHF studyMeyer S, Teerlink JR, Metra M, et al. - Clin Res Cardiol. 2017;106(4):280-292
There are important gender-related differences regarding the onset of heart failure (HF), the features of established chronic HF, and the clinical characteristics at admission for acute HF [1,2]. Compared with men, women have more often hypertension, atriumfibrilleren, preserved left ventricle ejection fraction (LVEF), a longer length of hospitalization, and receive less diuretic medication, whereas men are more likely to have a history of myocardial infarction, reduced LVEF, and specific medical and device treatment [3,4].
In this analysis of the RELAX-AHF study [5,6], the gender differences in early and persistent dyspnea relief were investigated. Moreover, patient features and HF characteristics in men and women hospitalized for acute HF were analyzed.
- The change in dyspnea visual analog scale AUC from baseline to day 5 did not vary by gender.
- A significantly higher proportion of women had moderate or marked dyspnea improvement measured by the Likert scale during the first 24 h.
- There were higher general wellbeing Likert score values in women through 24 h and through 5 days.
- Women were treated with lower total IV and oral loop diuretic doses through day 5, but dyspnea improved earlier moderately or markedly through day 5 in women.
- There were no relevant gender differences regarding body weight changes, worsening of HF, or outcomes.
- Women showed a trend towards longer ICU/CCU stays (4.05 ± 7.67 days vs. 3.51 ± 6.63 days; P = 0.0248) and total initial hospital stays (10.37 ± 9.62 days vs. 9.87 ± 9.17 days; P = 0.0258) compared to men.
- Physician-assessed signs and symptoms of congestion, such as dyspnea on exertion, orthopnea, edema or rales, did not vary by treatment and gender.
- Women did not have different outcomes compared with men in any of the analyzed endpoints.
- The relationship of gender with outcomes did not vary by treatment with serelaxin or the presence of HFpEF.
- Using a multi-variable logistic regression model, male gender, age and total diuretic dose were independently and negatively associated with dyspnea improvement within 24 h.
In the RELAX-AHF study, women had better early dyspnea relief and improvement in general wellbeing compared with men, even after adjustment for age and LVEF. In-hospital and post-discharge clinical outcomes were similar between men and women.