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The Israel Nationwide Heart Failure Survey: Sex Differences in Early and Late Mortality for Hospitalized Heart Failure Patients

  • Robert Klempfner
    Affiliations
    Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel

    Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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  • Edward Koifman
    Affiliations
    Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel

    Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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  • Ilan Goldenberg
    Affiliations
    Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel

    Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ashraf Hamdan
    Affiliations
    Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel

    Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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  • Geoffrey H. Tofler
    Affiliations
    University of Sydney, Sydney, Australia

    Royal North Shore Hospital, St Leonards, Sydney, Australia
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  • Eran Kopel
    Correspondence
    Reprint requests: Eran Kopel, MD, MPH, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel. Tel: (+972) (3) 530 3068; Fax: (+972) (3) 530 3084.
    Affiliations
    Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel
    Search for articles by this author
Published:December 27, 2013DOI:https://doi.org/10.1016/j.cardfail.2013.12.016

      Abstract

      Background

      Current data on the influence of sex on the prognosis of heart failure (HF) are conflicting, possibly owing to the use of different end points and a heterogeneous heart failure population in earlier studies. We sought to evaluate the effect of sex on the risk of early and late mortality outcomes after hospitalization for acute heart failure.

      Methods and Results

      The prospective cohort study population comprised 2,212 hospitalized patients with acute HF enrolled in a multicenter national survey in Israel. Cox proportional-hazards regression modeling was used to evaluate the effect of sex on the risk of early (≤6 months) and late (>6 months to 4 years) mortality after the index hospitalization. Among the study patients, 998 (45%) were women. Women with HF displayed significantly different clinical characteristics compared with men, including older age, higher frequency of HF with preserved ejection fraction and hypertensive heart disease, and lower percentage of coronary artery disease (all P < .001). The fully adjusted multivariable analyses for mortality outcomes showed that women tended toward an increased risk for early (≤6 months) mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.96–1.41; P = .13), whereas men had significantly increased risk for late (>6 months) mortality (HR 1.25, 95% CI 1.09–1.43; P = .001).

      Conclusions

      There are important differences in the clinical characteristics and the short- and long-term outcomes between men and women hospitalized with acute HF after adjusting for multiple confounding variables.

      Key Words

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