Elsevier

American Heart Journal

Volume 163, Issue 3, March 2012, Pages 430-437.e3
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Sex differences in in-hospital mortality in acute decompensated heart failure with reduced and preserved ejection fraction

https://doi.org/10.1016/j.ahj.2011.12.013Get rights and content

Background

There are no sex-specific survival comparisons between patients with heart failure (HF) with reduced and those with preserved ejection fraction. Large registries noting women have better survival than men combined HF patients with reduced and preserved EF. Other registries that compared patients with reduced and preserved EF did not analyze their data by sex. We sought to evaluate sex/EF differences in mortality and risk factors for survival in hospitalized patients with HF.

Methods

We included hospitals fully participating in Get With The Guidelines-Heart Failure that admitted HF patients with reduced (EF <40%) or preserved (EF ≥50%) EF. The primary end point was in-hospital mortality. Multivariate generalized estimating equation logistic models were used to compute odds ratios accounting for hospital clustering.

Results

The study cohort consisted of 51,428 patients with EF <40% (36% women, 64% men) and 37,699 patients with EF ≥50% (65% women, 35% men). Women compared with men with reduced and preserved EF were older and more likely to have hypertension, depression, or valvular heart disease and less likely to have coronary artery disease or peripheral vascular disease. There were no sex differences in in-hospital mortality (EF <40%, 2.69% women vs 2.89% men, P = .20; EF ≥50%, 2.61% women vs 2.62% men, P = .96), and risk factors such as age, systolic blood pressure, heart rate, and history of renal failure/dialysis were highly predictive of death for each sex/EF subgroup.

Conclusions

In a large, multicenter registry, we found that despite differences in baseline characteristics, women and men with reduced and preserved EF have similar in-hospital mortality and risk factors predicting death.

Section snippets

Data source

Data were obtained from the American Heart Association GWTG-HF registry, which has been previously described.9, 10, 11 Hospitals participating in the registry use a Web-based patient management tool (Outcomes Sciences Inc, Cambridge, MA) to collect data for consecutive patients admitted with HF to receive recommendations for qualitative improvement in medical management. Patients hospitalized with new or worsening HF or patients who developed significant HF symptoms such that HF was the primary

Results

The study cohort consisted of 51,428 patients admitted with HF and reduced EF (36% female, 64% male) and 37,699 patients admitted with HF and preserved EF (65% female, 35% male) from 264 GWTG-HF hospitals. Table I shows the baseline characteristics of the cohort according to sex and EF. Patients with HF with reduced EF compared with preserved EF were younger, more likely to be black, less likely to be female; and more likely to have prior HF and higher serum BNP levels on admission. Women

Discussion

In a large, multicenter, national HF registry, we found that despite differences in baseline characteristics, women and men with reduced and preserved EF have similar in-hospital mortality and share many risk factors predicting in-hospital mortality, such as age, systolic blood pressure, heart rate, and history of renal failure/dialysis. Women compared with men with reduced and preserved EF were older and more likely to have hypertension, depression, and valvular heart disease and were less

Conclusions

In a large, multicenter registry, we found that despite substantial differences in baseline characteristics, women and men with reduced and preserved EF have similar in-hospital mortality during an admission for acute decompensated HF. In addition, risk factors including age, systolic blood pressure, heart rate, and history of renal failure/dialysis were highly and similarly predictive of short-term death for men and women with preserved and reduced EF. These findings expand the knowledge base

References (36)

  • M. Piro et al.

    Sex-related differences in myocardial remodeling

    J Am Coll Cardiol

    (2010)
  • S. Parashar et al.

    Race, gender, and mortality in adults > or =65 years of age with incident heart failure (from the Cardiovascular Health Study)

    Am J Cardiol

    (2009)
  • R.D. Kociol et al.

    Generalizability and longitudinal outcomes of a national heart failure clinical registry: comparison of Acute Decompensated Heart Failure National Registry (ADHERE) and non-ADHERE Medicare beneficiaries

    Am Heart J

    (2010)
  • M.S. Nieminen et al.

    Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II

    Eur J Heart Fail

    (2008)
  • E. O'Meara et al.

    Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program

    Circulation

    (2007)
  • I. Vaartjes et al.

    Age- and gender-specific risk of death after first hospitalization for heart failure

    BMC Public Health

    (2010)
  • R.S. Bhatia et al.

    Outcome of heart failure with preserved ejection fraction in a population-based study

    N Engl J Med

    (2006)
  • T.E. Owan et al.

    Trends in prevalence and outcome of heart failure with preserved ejection fraction

    N Engl J Med

    (2006)
  • Cited by (0)

    Funding and relationship with industry: The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. The GWTG-HF program is currently supported, in part, by an unrestricted educational grant from Medtronic, Inc. It has been funded in the past through support from GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Eileen Hsich receives funding from American Heart Association Scientist Development Grant 0730307N (E.H.). Adrian Hernandez receives funding from Johnson & Johnson and Amylin and has received honorarium from Amgen and Corthera. Deepak Bhatt receives funding from Amarin, Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, and The Medicines Company. Gregg Fonarow is a consultant for Novartis.

    James L Januzzi, MD served as guest editor for this article.

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