Key result
Female sex is not independently linked to higher in-hospital myocarditis mortality versus males.
Why the study?
Occurrence and presentation of myocarditis may differ between genders, but the gender effect had not been studied in large patient populations.
Does the occurrence and clinical presentation of myocarditis differ between male and female patients?
Observational (n=3,274)
Yes
Does the occurrence and clinical presentation of myocarditis differ between male and female patients?
Odds Ratio: 2.9 (95% CI 1.4–6.2)
Absolute Event Rate: 1.6% vs 0.6%
p-value: p=0.006
Clinicians should not assume higher female myocarditis mortality risk from unadjusted data; leaves open independent sex effects after adjustment.
Purpose: Experimental and clinical studies suggest that occurrence and presentation of myocarditis may differ between genders, but the gender effect has not been studied in large patient populations. We studied the gender differences in myocarditis using a large nationwide hospital registry. Methods: Data of all hospital treatment periods due to myocarditis during May 2000 - October 2009 were collected from national Finnish registry. Registry included all treatment periods (1.7 million) of patients aged ≥ 16 years in medical and cardiological wards of 29 hospitals nationwide (all university and central hospitals and eight regional hospitals across the country). Results: During the 9.5 year period there were 3274 hospitalizations due to myocarditis. Myocarditis was notably more common in males (75.5% (95% CI 74.0-76.9%) of patients) than in females (24.5% (23.0-26.0%), p<0.0001). Male myocarditis patients were significantly younger than female patients (mean age 34.3±SD 15.2 vs. 49±18.4 years, p<0.0001). Duration of hospital treatment was similar between genders (mean 5.4±4.5 days). In-hospital mortality rate was higher in women (1.6% (0.9-2.8%) vs. 0.6% (0.3-0.9%), OR=2.9 (1.4-6.2), p=0.006), but difference was non-significant when adjusted for age and other disease. Heart failure was more common in women treated for myocarditis (5.0% (3.7-6.7%) vs. 1.5% (1.1-2.1%), adjusted OR=1.6 (1.0-2.7), p=0.05). Ventricular tachycardia, ventricular fibrillation or resuscitation complicated myocarditis more commonly in women (3.0% (2.0-4.4%) vs. 0.7% (0.5-1.2%), adjusted OR=3.3 (1.7-6.5), p<0.001). Women treated for myocarditis also had II or III degree AV-block more commonly than men (1.6% (1.0-2.8%) vs. 0.3% (0.1-0.6%), adjusted OR=4.8 (1.8-13.7), p=0.002). Established etiology of myocarditis did not differ between genders. Conclusions: Myocarditis is significantly more common in males. Female patients with myocarditis are older than male patients and appear to have more severe disease presentation.
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Kytö et al. (2013) conducted an observational in Myocarditis (n=3,274). Female gender vs. Male gender was evaluated on In-hospital mortality (OR 2.9, 95% CI 1.4-6.2, p=0.006). Female patients with myocarditis had higher unadjusted in-hospital mortality than males (1.6% vs 0.6%; OR 2.9, 95% CI 1.4-6.2), but the difference was non-significant after adjustment.
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