Influence of Sex on Treatment and Outcome in Chronic Heart Failure

Cardiovascular Therapeutics

Volumn 30, Issue 3, 2012, Pages 182-192

  Frankenstein, Lutz ^a   Clark, Andrew L ^b   Ribeiro, Jorge P ^c  

^a UNIVERSITY OF HEIDELBERG   (Germany)

^b UNIVERSITY OF HULL   (United Kingdom)

^c HOSPITAL DE CLÍNICAS DE PORTO ALEGRE   (Brazil)

Author keywords

Ace inhibitor; Adherence; Aldosterone antagonist; Angiotensin receptor blocker; Beta blocker; Gender; Heart failure; Medication; Outcome; Sex; Survival; Treatment

Indexed keywords

ACETYLSALICYLIC ACID; ALDOSTERONE; ALDOSTERONE ANTAGONIST; ANGIOTENSIN RECEPTOR ANTAGONIST; ANTICOAGULANT AGENT; ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BISOPROLOL; CANDESARTAN; CAPTOPRIL; CARVEDILOL; DIGOXIN; DIPEPTIDYL CARBOXYPEPTIDASE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; EPLERENONE; ESTROGEN; LOSARTAN; METOPROLOL; NEBIVOLOL; PLACEBO; RAMIPRIL; RENIN; RENIN INHIBITOR; SPIRONOLACTONE; VALSARTAN; WARFARIN;

ADJUVANT THERAPY; ANTICOAGULANT THERAPY; CLINICAL PROTOCOL; CLINICAL TRIAL (TOPIC); COHORT ANALYSIS; COMORBIDITY; DISEASE REGISTRY; DIURETIC THERAPY; DRUG BLOOD LEVEL; DRUG EFFICACY; DRUG SAFETY; EVIDENCE BASED MEDICINE; HEALTH SURVEY; HEART ATRIUM FIBRILLATION; HEART DEATH; HEART FAILURE; HEART INFARCTION; HOSPITALIZATION; HUMAN; HYPERTENSION; META ANALYSIS; MORBIDITY; MORTALITY; PATIENT COMPLIANCE; PRACTICE GUIDELINE; PRESCRIPTION; PRIORITY JOURNAL; PROGNOSIS; RECOMMENDED DRUG DOSE; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; REVIEW; RISK BENEFIT ANALYSIS; RISK FACTOR; SEX DIFFERENCE; STROKE; SURVIVAL RATE; TREATMENT FAILURE; TREATMENT INDICATION; TREATMENT OUTCOME; UNSPECIFIED SIDE EFFECT;

AGED; CARDIOVASCULAR AGENTS; CHRONIC DISEASE; EVIDENCE-BASED MEDICINE; FEMALE; GUIDELINE ADHERENCE; HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS DISPARITIES; HEALTHCARE DISPARITIES; HEART FAILURE; HUMANS; MALE; MEDICATION ADHERENCE; MIDDLE AGED; PHYSICIAN'S PRACTICE PATTERNS; PRACTICE GUIDELINES AS TOPIC; SELF CARE; SEX FACTORS; SURVIVAL ANALYSIS; TREATMENT OUTCOME;

EID: 84860619999     PISSN: 17555914     EISSN: 17555922     Source Type: Journal    
DOI: 10.1111/j.1755-5922.2010.00253.x     Document Type: Review

References (113)

1. Nieminen MS, Harjola VP, Hochadel M, et al. Gender related differences in patients presenting with acute heart failure. Results from Euro Heart Failure Survey II. Eur J Heart Fail 2008;10:140-148.
2. Piña IL, Kokkinos P, Kao A, et al. HF-ACTION Investigators. Baseline differences in the HF-ACTION trial by sex. Am Heart J 2009;158:S16-S23.
3. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996;275:1557-1562.
4. Masoudi FA, Havranek EP, Smith G, Fish RH, Steiner JF, Ordin DL, Krumholz HM. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 2003;41:217-223.
5. Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: Prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999;33:1948-1955.
6. Modena MG, Muia N Jr, Aveta P, Molinari R, Rossi R. Effects of transdermal 17 beta-estradiol on left ventricular anatomy and performance in hypertensive women. Hypertension 1999;34:1041-1046.
7. Thireau J, Aimond F, Poisson D, et al. New insights into sexual dimorphism during progression of heart failure and rhythm disorders. Endocrinology 2010
8. Heiat A, Gross CP, Krumholz HM. Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 2002;162:1682-1688.
9. Anderson GD. Gender and racial differences in pharmacological response: Where is the evidence? Pharmacogenetics, pharmacokinetics, and pharmacodynamics. J Womens Health (Larchmt) 2005;14:19-29.
10. Lenzen MJ, Boersma E, Reimer WJ, et al. Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: A report from the Euro Heart Survey on Heart Failure. Eur Heart J 2005;26:2706-2713.
11. McKinnon ME, McKee CM. Heart failure: The Cinderella of cardiology? Public Health 1996;110:351-355.
12. Hsich EM, Piña IL. Heart failure in women: A need for prospective data. J Am Coll Cardiol 2009;54:491-498.
13. Stafford RS, Saglam D, Blumenthal D. National patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure. Arch Intern Med 1997;157:2460-2464.
14. Mejhert M, Holmgren J, Wandell P, Persson H, Edner M. Diagnostic tests, treatment and follow-up in heart failure patients-Is there a gender bias in the coherence to guidelines? Eur J Heart Fail 1999;1:407-410.
15. Bungard TJ, McAlister FA, Johnson JA, Tsuyuki RT. Underutilisation of ACE inhibitors in patients with congestive heart failure. Drugs 2001;61:2021-2033.
16. Agvall B, Dahlström U. Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences. Scand J Prim Health Care 2001;19:14-19.
17. Boyles PJ, Peterson GM, Bleasel MD, Vial JH. Undertreatment of congestive heart failure in an Australian setting. J Clin Pharm Ther 2004;29:15-22.
18. Jankowski P, Kawecka-Jaszcz K, Czarnecka D, et al. Gender does not influence event-free survival in patients with ischaemic heart disease undergoing non-emergency coronary angiography. A single centre analysis. Kardiol Pol 2007;65:475-484.
19. Muntwyler J, Cohen-Solal A, Freemantle N, Eastaugh J, Cleland JG, Follath F. Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe. Eur J Heart Fail 2004;6:663-668.
20. Yancy CW, Fonarow GC, Albert NM, et al. Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: Findings from IMPROVE HF. Am Heart J 2009;157:754-762.
21. Clinical Quality Improvement Network Investigators. Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure. The relative importance of age, sex, and medical therapy. Arch Intern Med 1996;156:1669-1673.
22. Opasich C, De Feo S, Ambrosio GA, et al. TEMISTOCLE Investigators. The 'real' woman with heart failure. Impact of gender on current in-hospital management of heart failure by cardiologists and internists. Eur J Heart Fail 2004;6:769-779.
23. Nicol ED, Fittall B, Roughton M, Cleland JG, Dargie H, Cowie MR. NHS heart failure survey: A survey of acute heart failure admissions in England, Wales and Northern Ireland. Heart 2008;94:172-177.
24. Lenzen MJ, Rosengren A, Scholte op Reimer WJ, et al. Management of patients with heart failure in clinical practice: Differences between men and women. Heart 2008;94:e10.
25. Rathore SS, Foody JM, Wang Y, et al. Sex, quality of care, and outcomes of elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project. Am Heart J 2005;149:121-128.
26. Kostis JB, Shelton B, Gosselin G, et al. SOLVD Investigators. Adverse effects of enalapril in the studies of left ventricular dysfunction (SOLVD). Am Heart J 1996;131:350-355.
27. Shah MR, Granger CB, Bart BA, et al. Sex-related differences in the use and adverse effects of angiotensin-converting enzyme inhibitors in heart failure: The study of patients intolerant of converting enzyme inhibitors registry. Am J Med 2000;109:489-492.
28. Lupón J, Urrutia A, González B, et al. Does heart failure therapy differ according to patient sex? Clin Cardiol 2007;30:301-305.
29. Frankenstein L, Remppis A, Fluegel A, Doesch A, Katus HA, Senges J, Zugck C. The association between long-term longitudinal trends in guideline adherence and mortality in relation to age and sex. Eur J Heart Fail 2010.
30. Frazier CG, Alexander KP, Newby LK, et al. Associations of gender and etiology with outcomes in heart failure with systolic dysfunction: A pooled analysis of 5 randomized control trials. J Am Coll Cardiol 2007;49:1450-1458.
31. Granger BB, Ekman I, Granger CB, et al. Adherence to medication according to sex and age in the CHARM programme. Eur J Heart Fail 2009;11:1092-1098.
32. Heo S, Moser DK, Lennie TA, Riegel B, Chung ML. Gender differences in and factors related to self-care behaviors: A cross-sectional, correlational study of patients with heart failure. Int J Nurs Stud 2008;45:1807-1815.
33. Lee CS, Riegel B, Driscoll A, et al. Gender differences in heart failure self-care: A multinational cross-sectional study. Int J Nurs Stud 2009;46:1485-1495.
34. Luttik ML, Jaarsma T, Lesman I, Sanderman R, Hagedoorn M. Quality of life in partners of people with congestive heart failure: Gender and involvement in care. J Adv Nurs 2009;65:1442-1451.
35. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: A meta-analytic review. JAMA 2002;288:756-764.
36. Baumhäkel M, Müller U, Böhm M. Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study. Eur J Heart Fail 2009;11:299-303.
37. Harjai KJ, Nunez E, Stewart Humphrey J, Turgut T, Shah M, Newman J. Does gender bias exist in the medical management of heart failure? Int J Cardiol 2000;75:65-69.
38. Fowler MB, Lottes SR, Nelson JJ, et al. COHERE Participant Physicians. Beta-blocker dosing in community-based treatment of heart failure. Am Heart J 2007;153:1029-1036.
39. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002;347:1397-1402.
40. Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ. Trends in heart failure incidence and survival in a community-based population. JAMA 2004;292:344-350.
41. Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P. Sex differences in the prognosis of congestive heart failure: Results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation 2001;103:375-380.
42. Ghali JK, Pina IL, Gottlieb SS, Deedwania PC, Wikstrand JC. Metoprolol CR/XL in female patients with heart failure: Analysis of the experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation 2002;105:1585-1591.
43. Gustafsson F, Torp-Pedersen C, Burchardt H, et al. Female sex is associated with a better long-term survival in patients hospitalized with congestive heart failure. Eur Heart J 2004;25:129-135.
44. Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 2002;347:1403-1411.
45. Sheppard R, Behlouli H, Richard H, Pilote L. Effect of gender on treatment, resource utilization, and outcomes in congestive heart failure in Quebec, Canada. Am J Cardiol 2005;95:955-959.
46. Ng AC, Wong HS, Yong AS, Sindone AP. Impact of gender on outcomes in chronic systolic heart failure. Int J Cardiol 2007;117:214-221.
47. Opasich C, Tavazzi L, Lucci D, Gorini M, Albanese MC, Cacciatore G, Maggioni AP. Comparison of one-year outcome in women versus men with chronic congestive heart failure. Am J Cardiol 2000;86:353-357.
48. Pons F, Lupón J, Urrutia A, et al. Mortality and cause of death in patients with heart failure: Findings at a specialist multidisciplinary heart failure unit. Rev Esp Cardiol 2010;63:303-314.
49. Bourassa MG, Gurne O, Bangdiwala SI, et al. The Studies of Left Ventricular Dysfunction (SOLVD) Investigators. Natural history and patterns of current practice in heart failure. J Am Coll Cardiol 1993;22:14A-19A.
50. Ghali JK, Krause-Steinrauf HJ, Adams KF, et al. Gender differences in advanced heart failure: Insights from the BEST study. J Am Coll Cardiol 2003;42:2128-2134.
51. Granger BB, Swedberg K, Ekman I, et al. CHARM investigators. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: Double-blind, randomised, controlled clinical trial. Lancet 2005;366:2005-2011.
52. O'Meara E, Clayton T, McEntegart MB, et al. CHARM Investigators. Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: Results of the candesartan in heart failure: Assessment of reduction in mortality and morbidity (CHARM) program. Circulation 2007;115:3111-3120.
53. Ahmed MI, Lainscak M, Mujib M, et al. Gender-related dissociation in outcomes in chronic heart failure: Reduced mortality but similar hospitalization in women. Int J Cardiol 2009. doi:
54. Franciosa JA, Nelson JJ, Lukas MA, et al. COHERE Participant Physicians. Heart failure in community practice: Relationship to age and sex in a beta-blocker registry. Congest Heart Fail 2006;12:317-323.
55. Velavan P, Khan NK, Goode K, et al. Predictors of short term mortality in heart failure- insights from the Euro Heart Failure survey. Int J Cardiol 2010;138:63-69.
56. Fonarow GC, Abraham WT, Albert NM, et al; OPTIMIZE-HF Investigators and Hospitals. Age- and gender-related differences in quality of care and outcomes of patients hospitalized with heart failure (from OPTIMIZE-HF). Am J Cardiol 2009;104:107-115.
57. de Groote P, Lamblin N, Mouquet F, Bauters C. No gender survival difference in a population of patients with chronic heart failure related to left ventricular systolic dysfunction and receiving optimal medical therapy. Arch Cardiovasc Dis 2008;101:242-248.
58. Patten RD. Models of gender differences in cardiovascular disease. Drug Discov Today Dis Models 2007;4:227-232.
59. Fischer M, Baessler A, Schunkert H. Renin angiotensin system and gender differences in the cardiovascular system. Cardiovasc Res 2002;53:672-677.
60. Shepherd J, Cobbe SM, Ford I, et al. West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-1307.
61. Wedel H, Demets D, Deedwania P, et al. MERIT-HF Study Group. Challenges of subgroup analyses in multinational clinical trials: experiences from the MERIT-HF trial. Am Heart J 2001;142:502-511.
62. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342:821-828.
63. Garg R, Yusuf S Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995;273:1450-1456.
64. Flather MD, Yusuf S, Kober L, et al. ACE-Inhibitor Myocardial Infarction Collaborative Group. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: A systematic overview of data from individual patients. Lancet 2000;355:1575-1581.
65. Arnold JM, Yusuf S, Young J, et al. HOPE Investigators. Prevention of heart failure in patients in the heart outcomes prevention evaluation (HOPE) study. Circulation 2003;107:1284-1290.
66. Lonn E, Roccaforte R, Yi Q, et al. HOPE Investigators. Heart outcomes prevention evaluation. Effect of long-term therapy with ramipril in high-risk women. J Am Coll Cardiol 2002;40:693-702.
67. Keyhan G, Chen SF, Pilote L. Angiotensin-converting enzyme inhibitors and survival in women and men with heart failure. Eur J Heart Fail 2007;9:594-601.
68. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001-2007.
69. Packer M, Coats AJ, Fowler MB, et al. Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001;344:1651-1658.
70. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH. U.S. Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996;334:1349-1355.
71. Flather MD, Shibata MC, Coats AJ, et al. SENIORS Investigators. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26:215-225.
72. Keyhan G, Chen SF, Pilote L. The effectiveness of beta-blockers in women with congestive heart failure. J Gen Intern Med 2007;22:955-961.
73. Pitt B, Poole-Wilson PA, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: Randomised trial-the Losartan Heart Failure Survival Study ELITE II. Lancet 2000;355:1582-1587.
74. Os I, Franco V, Kjeldsen SE, et al. Effects of losartan in women with hypertension and left ventricular hypertrophy: Results from the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 2008;51:1103-1108.
75. Cohn JN, Tognoni G. Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667-1675.
76. Pfeffer MA, Swedberg K, Granger CB, et al. CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: The CHARM-Overall programme. Lancet 2003;362:759-766.
77. Hudson M, Rahme E, Behlouli H, Sheppard R, Pilote L. Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure-a population study. Eur J Heart Fail 2007;9:602-609.
78. Strauss MH, Hall A. RAS blockers: Does sex matter? Re: Sex differences in the effectiveness of ARB and ACEI in patients with congestive heart failure-a population study: Marie Hudson et al. European Journal of Heart Failure 9 (2007) 602-609. Eur J Heart Fail 2007;9:963-964.
79. Pitt B, Zannad F, Remme WJ, et al. Randomized Aldactone Evaluation Study Investigators. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999;341:709-717.
80. Pitt B, Remme W, Zannad F, et al. Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309-1321.
81. Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the Randomized Aldactone Evaluation Study [RALES]). Am J Cardiol 1996;78:902-907.
82. Cicoira M, Zanolla L, Rossi A, et al. Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 2002;40:304-310.
83. Akbulut M, Ozbay Y, Ilkay E, Karaca I, Arslan N. Effects of spironolactone and metoprolol on QT dispersion in heart failure. Jpn Heart J 2003;44:681-692.
84. Agostoni P, Magini A, Andreini D, et al. Spironolactone improves lung diffusion in chronic heart failure. Eur Heart J 2005;26:159-164.
85. Berry C, Murphy NF, De Vito G, et al. Effects of aldosterone receptor blockade in patients with mild-moderate heart failure taking a beta-blocker. Eur J Heart Fail 2007;9:429-434.
86. Chan AK, Sanderson JE, Wang T, et al. Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure. J Am Coll Cardiol 2007;50:591-596.
87. Gao X, Peng L, Adhikari CM, Lin J, Zuo Z. Spironolactone reduced arrhythmia and maintained magnesium homeostasis in patients with congestive heart failure. J Card Fail 2007;13:170-177.
88. Rodríguez JA, Godoy I, Castro P, et al. Effects of ramipril and spironolactone on ventricular remodeling after acute myocardial infarction: Randomized and double-blind study. Rev Med Chil 1997;125:643-652.
89. Pitt B, Roniker B. Eplerenone, a novel selective aldosterone receptor antagonist (SARA): Dose finding study in patients with heart failure. J Am Coll Cardiol 1999;15:188A.
90. Ezekowitz JA, McAlister FA. Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials. Eur Heart J 2009;30:469-477.
91. Sze E, Moss AJ, Mc Nitt S, Barsheshedt A, Andrews ML, Zareba W, Goldenberg I, for the Multicenter Automatic Defibrillator Implantation Trial-II Investigators. Risk factors for recurrent heart failure events in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). J Cardiovasc Electrophysiol 2010.
92. Harjai KJ, Dinshaw HK, Nunez E, Shah M, Thompson H, Turgut T, Ventura HO. The prognostic implications of outpatient diuretic dose in heart failure. Int J Cardiol 1999;71:219-225.
93. Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E. Diuretic use, progressive heart failure, and death in patients in the Studies of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003;42:705-708.
94. Ahmed A, Young JB, Love TE, Levesque R, Pitt B. A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol 2008;125:246-53.
95. Eshaghian S, Horeich TB, Foranow GC. Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 2006;97:1759-1764.
96. Neuberg GW, Miller AB, O'Connor CM, et al. PRAISE Investigators. Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J 2002;144:31-38.
97. Ahmed A, Husain A, Love TE, et al. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: An observational study using propensity score methods. Eur Heart J 2006;27:1431-1439.
98. Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 2002;347:1403-1411.
99. Rathore SS, Curtis JP, Wang Y, Bristow MR, Krumholz HM. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003;289:871-878.
100. Adams KF Jr, Patterson JH, Gattis WA, O'Connor CM, Lee CR, Schwartz TA, Gheorghiade M. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: A retrospective analysis. J Am Coll Cardiol 2005;46:497-504.
101. Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: A comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006;27:178-186.
102. Ahmed A, Aban IB, Weaver MT, Aronow WS, Fleg JL. Serum digoxin concentration and outcomes in women with heart failure: A bi-directional effect and a possible effect modification by ejection fraction. Eur J Heart Fail 2006;8:409-419.
103. Ahmed A, Pitt B, Rahimtoola SH, Waagstein F, White M, Love TE, Braunwald E. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: A propensity-matched study of the DIG trial. Int J Cardiol 2008;123:138-146.
104. Digitalis Investigation Group; Ahmed A, Waagstein F, Pitt B, White M, Zannad F, Young JB, Rahimtoola SH. Effectiveness of digoxin in reducing one-year mortality in chronic heart failure in the Digitalis Investigation Group trial. Am J Cardiol 2009;103:82-87.
105. Cleland JG, Findlay I, Jafri S, et al. The Warfarin/Aspirin Study in Heart failure (WASH): A randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J 2004;148:157-164.
106. Massie BM, Collins JF, Ammon SE, et al. WATCH Trial Investigators Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. Circulation 2009;119:1616-1624.
107. Pullicino P, Thompson JL, Barton B, Levin B, Graham S, Freudenberger RS. WARCEF Investigators. Warfarin versus aspirin in patients with reduced cardiac ejection fraction (WARCEF): Rationale, objectives, and design. J Card Fail 2006;12:39-46.
108. Al-Khadra AS, Salem DN, Rand WM, Udelson JE, Smith JJ, Konstam MA. Warfarin anticoagulation and survival: A cohort analysis from the Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 1998;31:749-753.
109. de Groote P, Lamblin N, Mouquet F, Bauters C. No gender survival difference in a population of patients with chronic heart failure related to left ventricular systolic dysfunction and receiving optimal medical therapy. Arch Cardiovasc Dis 2008;101:242-248.
110. Riesgo A, Herrero P, Llorens P, Jacob J, Martín-Sánchez FJ, Bragulat E, Miró O. en nombre del grupo EAFHE. Influence of patient's sex in the form of presentation and the management of acute heart failure in Spanish emergency rooms. Med Clin (Barc) 2010;134:671-677.
111. Lee WY, Capra AM, Jensvold NG, Gurwitz JH, Go AS. Epidemiology, Practice, Outcomes, and Cost of Heart Failure (EPOCH) Study. Gender and risk of adverse outcomes in heart failure. Am J Cardiol 2004;94:1147-1152.
112. Cleland JG, Swedberg K, Follath F, et al. Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Euro Heart Failure survey programme-a survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. Eur Heart J 2003;24:442-463.
113. Komajda M, Follath F, Swedberg K, et al. Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Euro Heart Failure Survey programme-a survey on the quality of care among patients with heart failure in Europe. Part 2: Treatment. Eur Heart J 2003;24:464-474.