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. 2021 Dec;8(6):5031-5039.
doi: 10.1002/ehf2.13567. Epub 2021 Sep 6.

Gender differences in characteristics and outcomes in heart failure patients referred for end-stage treatment

Nina Fluschnik  1   2 , Felix Strangl  1 , Christoph Kondziella  1 , Alina Goßling  1 , Peter Moritz Becher  1   2 , Benedikt Schrage  1   2 , Renate B Schnabel  1   2 , Julia Bernadyn  1 , Wiebke Bremer  1 , Hanno Grahn  1 , Alexander M Bernhardt  3 , Hermann Reichenspurner  3 , Meike Rybczynski  1 , Stefan Blankenberg  1   2 , Paulus Kirchhof  1   2 , Christina Magnussen  1   2 , Dorit Knappe  1
Affiliations

Gender differences in characteristics and outcomes in heart failure patients referred for end-stage treatment

Nina Fluschnik et al. ESC Heart Fail. 2021 Dec.

Abstract

Aims: Despite signals from clinical trials and mechanistic studies implying different resilience to heart failure (HF) depending on gender, the impact of gender on presentation and outcomes in patients with HF remains unclear. This study assessed the impact of gender on clinical presentation and outcomes in patients with HF referred to a specialised tertiary HF service.

Methods and results: Consecutive patients with HF referred to a specialised tertiary HF service offering advanced therapy options including left ventricular assist devices (LVAD) and heart transplantation were prospectively enrolled from August 2015 until March 2018. We assessed clinical characteristics at baseline and performed survival analyses and age-adjusted Cox regression analyses in men vs. women for all-cause death and a combined disease-related endpoint comprising death, heart transplantation, and LVAD implantation. Analyses were performed for the overall study population and for patients with HF with reduced ejection fraction (HFrEF). Of 356 patients included, 283 (79.5%) were male. The median age was 58 years (interquartile range 50-67). Two hundred and fifty-one (74.5%) patients had HFrEF. HF aetiology, ejection fraction, functional status measures, and most of the cardiac and non-cardiac comorbidities did not differ between men and women. In a median follow-up of 3.2 years, 50 patients died (45 men, 5 women), 15 patients underwent LVAD implantation, and 8 patients heart transplantation. While all-cause death was not significantly different between both genders in the overall population [16.9 vs. 6.0%, P = 0.065, hazard ratio (HR) 2.29 (95% confidence interval 0.91-5.78), P = 0.078], in the HFrEF subgroup, a significant difference between men and women was observed [20.7% vs. 3.9%, P = 0.017, HR 3.67 (95% confidence interval 1.13-11.91), P = 0.031]. The combined endpoint was more often reached in men than in women in both the overall population [21.6% vs. 9.0%, P = 0.053, HR 2.51 (1.08-5.82), P = 0.032] and the HFrEF subgroup [27.1% vs. 7.7%, P = 0.015, HR 3.58 (1.29-9.94), P = 0.014].

Conclusions: Patients referred to a specialised tertiary HF service showed a similar clinical profile without relevant gender differences. In the mid-term follow-up, more male than female patients died or underwent heart transplantation and LVAD implantation. These findings call for independent validation and for further research into gender-specific drivers of HF progression.

Keywords: All-comers cohort; Gender differences; Heart failure.

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Conflict of interest statement

A.M.B. reports personal fees from Abbott, Abiomed, AstraZeneca, BerlinHeart, Medtronic, and Novartis (unrelated to the submitted work).

B.S. received funding from the German Research Foundation and the Else Kroener‐Fresenius‐Stiftung and speakers fees from AstraZeneca, all outside the submitted work.

C.M. receives funding from the German Center for Cardiovascular Research (DZHK) within the Promotion of Women Scientists' programme and from the Deutsche Stiftung fuer Herzforschung unrelated to the current work. C.M. has received speaker fees from Astra Zeneca, Novartis, and Loewenstein medical outside this work.

H.R. has received honoraria from Abiomed and Medtronic (unrelated to the submitted work).

P.K. receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation, and has received honoraria from several such companies in the past, but not in the last 3 years (unrelated to the submitted work). P.K. is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).

P.M.B. received funding from the German Research Foundation outside the submitted work.

R.B.S. has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme under the grant agreement no. 648131, from the European Union's Horizon 2020 research and innovation programme under the grant agreement no. 847770 (AFFECT‐EU), and from the German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103), German Ministry of Research and Education (BMBF 01ZX1408A), and ERACoSysMed3 (031L0239) (unrelated to the submitted work). RBS conflicts: RBS has received lecture fees and advisory board fees from BMS/Pfizer outside this work.

S.B. has received speakers fee from Medtronic, Pfizer, Roche, Novartis, and SiemensDiagnostics (unrelated to the submitted work).

Figures

Figure 1
Figure 1
Profile of met endpoints according to gender. HTx, heart transplantation; LVAD, left ventricular assist devices.
Figure 2
Figure 2
Kaplan–Meier curves for all patients ‘freedom from death’ stratified by gender (A) and Kaplan–Meier curves for heart failure with reduced ejection fraction patients for ‘freedom from death’ stratified by gender (B).
Figure 3
Figure 3
Kaplan–Meier curves for ‘freedom from death, heart transplantation, or left ventricular assist device implantation’ in heart failure (HF) patients stratified by gender (A) and Kaplan–Meier curves for HF with reduced ejection fraction patients ‘freedom from death, heart transplantation, or left ventricular assist device implantation’ in HF patients stratified by gender (B). HTx, heart transplantation; LVAD, left ventricular assist devices.
See this image and copyright information in PMC

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