Heart failure admission characteristics in women with a history of sexual or physical abuse: a case-control study

Abstract

Introduction: An emerging body of epidemiological evidence links a history of exposure to sexual and physical abuse or assault with an increased risk of developing cardiovascular disease. Understanding adverse physical health outcomes including heart failure (HF) in persons exposed to sexual and physical abuse is of particular importance to help improve multidisciplinary approaches to mental and physical wellbeing, including cardiovascular management, among vulnerable populations. Methods: This case-control study was performed at a tertiary hospital in metropolitan South Australia. At index HF admission 12 consecutive female patients with exposure to sexual and physical abuse or assault were identified from the trauma module of a structured psychiatric interview. Index admission data were classified into HF phenotype and aetiology using the criteria and definitions of the European Society of Cardiology. The presentation profile at index HF admission was compared to 12 gender and age-matched comparators. Results: The clinical characteristics at index admission showed that most patients presented with pulmonary rales, peripheral oedema, and pulmonary congestion (67-75%), with diuretics the most common intervention (75%). By comparison to the non-exposed group, we observed differences between groups in HF severity determined by New York Heart Association class, diastolic blood pressure (BP), and heart rate (HR) but not systolic BP, saturation of peripheral oxygen (Sp02) or HF phenotypes. There were no differences in troponin, creatinine, sodium, admission use of inotropes, vasodilators or diuretics, post-traumatic stress disorder or comorbidities between the exposed patients and age-matched female controls. Conclusion: Women with a history of experiencing sexual and physical abuse or assault presented with a unique HF admission profile characterised by lower BP and HR. The findings support previous work suggesting that persons experiencing sexual and physical abuse or assault have blunted cardiovascular reactivity to stressors such as hospital admission.