Sex and clinical outcomes in new-onset heart failure

Abstract

Background: Sex differences in heart failure (HF) presentation, management, and outcomes have been described, but data in new-onset acute HF are scarce. Our aim was to examine sex influence in clinical characteristics, treatment, and prognosis of patients admitted with new-onset HF.

Methods: The Spanish Network for the Study of Heart Failure III (REDINSCOR III) is a prospective registry that included consecutive adults admitted with new-onset acute HF. The primary outcome was 12-month mortality, with additional analyses on HF readmissions.

Results: The registry included 532 patients, 178 females (33.4 %). Compared to men, women were older (mean age 71.2 ± 13.1 vs. 65.7 ± 13.0 years, P < 0.001), more likely to live alone (24.9 % vs. 12.1 %, P = 0.001), and presented higher left ventricular ejection fraction (43.4 ± 15.2 % vs. 37.2 ± 13.6 %, P < 0.001), lower prevalence of prior cardiovascular disease, including myocardial infarction (15.0 % vs. 5.7 %, P = 0.002) and peripheral arterial disease (8.0 % vs. 2.3 %, P = 0.010). A total of 30 patients died during follow-up (5,6 %), mortality was similar in women and men (10 [5.6 %] vs. 20 [5.7 %], P = 0.988). Female sex was not independently associated with all-cause mortality (hazard ratio [HR]: 0.77, 95 % confidence interval [CI]: 0.34-1.74, P = 0.540), HF readmissions (HR: 1.29, 95 % CI: 0.66-2.53, P = 0.451), nor the combined outcome death/HF readmission (HR: 0.98, 95 % CI: 0.56-1.74, P = 0.972). All-cause mortality increased with age (HR: 4.32, 95 % CI: 1.72-10.81, P = 0.002) and was also influenced by hemoglobin levels (HR: 0.98, 95 % CI: 0.96-0.99, P = 0.006).

Conclusion: Sex does not seem to influence the prognosis of new-onset HF.

Keywords: Heart failure; Hospital readmissions; Mortality; Sex; Women.