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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiac Failure
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Relation between gender, etiology and survival in patients with symptomatic heart failure.J Am Coll Cardiol. 1996; 28: 1781-1788
- Gender differences in survival in advanced heart failure. Insights from the FIRST study.Circulation. 1999; 99: 1816-1821
- Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis.Eur J Heart Fail. 2012; 14: 473-479
- Hospitalizations after heart failure diagnosis a community perspective.J Am Coll Cardiol. 2009; 54: 1695-1702
- Sex differences in in-hospital mortality in acute decompensated heart failure with reduced and preserved ejection fraction.Am Heart J. 2012; 163 (437.e1–3): 430-437
- Gender differences in in-hospital management and outcomes in patients with decompensated heart failure: analysis from the Acute Decompensated Heart Failure National Registry (ADHERE).J Card Fail. 2006; 12: 100-107
- Clinical features and prognosis of heart failure in women. A 5-year prospective study.Int J Cardiol. 2009; 133: 327-335
- Comparison of women versus men hospitalized with heart failure (from a 20-year registry in a middle-eastern country 1991–2010).Am J Cardiol. 2012; 109: 395-400
- Gender differences in patients admitted with advanced decompensated heart failure.Am J Cardiol. 2008; 102: 454-458
- Gender differences in advanced heart failure: insights from the BEST study.J Am Coll Cardiol. 2003; 42: 2128-2134
- Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure.Am J Cardiol. 1998; 82: 76-81
- Female sex is associated with a better long-term survival in patients hospitalized with congestive heart failure.Eur Heart J. 2004; 25: 129-135
- Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure.Eur J Heart Fail. 2010; 12: 833-840
- The management, early and one year outcome in hospitalized patients with heart failure: a national Heart Failure Survey in Israel—HFSIS 2003.Isr Med Assoc J. 2007; 9: 227-233
- Late mortality and determinants in patients with heart failure and preserved systolic left ventricular function: the Israel Nationwide Heart Failure Survey.Isr Med Assoc J. 2007; 9: 234-238
- Mechanisms of sudden cardiac death in myocardial infarction survivors: insights from the randomized trials of implantable cardioverter-defibrillators.Circulation. 2007; 115: 2451-2457
- Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy.J Am Coll Cardiol. 1997; 30: 1002-1008
- Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.N Engl J Med. 1991; 325: 293-302
- Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT).Circulation. 2011; 124: 1527-1536
- Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment.Eur Heart J. 2011; 32: 670-679
- Diuretic use in heart failure and outcomes.Clin Pharmacol Ther. 2013; 94: 490-498
- Approaches to diuretic therapy and electrolyte imbalance in congestive heart failure [review].Cardiol Clin. 1994; 2: 37-50
- Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial.Eur J Heart Fail. 2007; 9: 1064-1069
- Diuretic strategies in patients with acute decompensated heart failure.N Engl J Med. 2011; 364: 797-805
- Sex-specific acute heart failure phenotypes and outcomes from PROTECT.Eur J Heart Fail. 2013; 15: 1374-1381
Shields DL. Calcium channel blockers as initial therapeutic agents in hypertension: relationship to incident heart failure. Biol Res Nurs. 2013 Jul 16. [Epub ahead of print].
- Frailty: an emerging research and clinical paradigm—issues and controversies.J Gerontol A Biol Sci Med Sci. 2007; 62: 731-737
- State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.Arch Phys Med Rehabil. 2003; 84: 890-897
- Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study.JAMA. 1998; 279: 585-592
- Frailty assessment in the cardiovascular care of older adults.J Am Coll Cardiol. 2014; 63: 747-762
- Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study.Arch Intern Med. 2002; 162: 2333-2341
- Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty.Annu Rev Med. 2000; 51: 245-270
- Frailty and risk for heart failure in older adults: the Health, Aging, and Body Composition study.Am Heart J. 2013; 166: 887-894
- Gender-related differences in hospitalized heart failure patients.Eur J Heart Fail. 2013; 15: 734-741
Published online: December 27, 2013
Accepted: December 18, 2013
Received in revised form: December 15, 2013
Received: February 24, 2013
The first 2 authors contributed equally to this work.
See page 197 for disclosure information.
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.