Impact of sex differences in co-morbidities and medication adherence on outcome in 25 776 heart failure patients

ESC Heart Fail. 2021 Feb;8(1):63-73. doi: 10.1002/ehf2.13113. Epub 2020 Nov 28.


Aims: Health insurance claims (HIC) databases in the Netherlands capture unselected patient populations, which makes them suitable for epidemiological research on sex differences. Based on a HIC database, we aimed to reveal sex differences in heart failure (HF) outcomes, with particular focus on co-morbidities and medication.

Methods and results: The Achmea HIC database included 14 517 men and 11 259 (45%) women with a diagnosis treatment code for chronic HF by January 2015. We related their sex, co-morbidities, and medication adherence (medication possession rate >0.8) with the primary endpoint (PE) of all-cause mortality or HF admission during a median follow-up of 3.3 years, using Cox regression. Median age of men and women was 72 and 76 years, respectively. Prevalence of co-morbidities and use of disease-modifying drugs was higher in men; however, medication adherence was similar. At the end of follow-up, 35.1% men and 31.8% women had reached the PE. The adjusted hazard ratio for men was 1.25 (95% confidence interval: 1.19-1.30). A broad range of co-morbidities was associated with the PE. Overall, these associations were stronger in women than in men, particularly for renal insufficiency, chronic obstructive pulmonary disease/asthma, and diabetes. Non-adherence to disease-modifying drugs was related with a higher incidence of the PE, with similar effects between sexes.

Conclusions: In a representative sample of the Dutch population, as captured in a HIC database, men with chronic HF had a 25% higher incidence of death or HF admission than women. The impact of co-morbidities on the outcome was sex dependent, while medication adherence was not.

Keywords: Big data; Co-morbidity; Heart failure; Hospitalisation; Medication adherence; Mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Heart Failure* / drug therapy
  • Heart Failure* / epidemiology
  • Humans
  • Incidence
  • Male
  • Medication Adherence
  • Netherlands / epidemiology
  • Sex Characteristics*