Elsevier

American Heart Journal

Volume 153, Issue 6, June 2007, Pages 1074-1080
American Heart Journal

Clinical Investigation
Congestive Heart Disease
Relation of sex to morbidity and mortality in patients with heart failure and reduced or preserved left ventricular ejection fraction

https://doi.org/10.1016/j.ahj.2007.03.016Get rights and content

Background

Previous studies indicate a survival advantage for women over men with chronic heart failure associated with reduced or preserved ejection fraction. Whether women with chronic heart failure are at less risk for hospitalization for worsening heart failure has not been well investigated.

Methods

Using data from the DIG trial, the relationship between sex and adverse outcomes, especially the risk of hospitalization for various causes, was evaluated in patients with reduced or preserved left ventricular ejection fraction.

Results

Survival was worse for men than women with either reduced (HR 1.48, 95% CI 1.33-1.65, P < .001) or preserved ejection fraction (HR 1.60, 95% CI 1.20-2.13, P = .001), with P =.406 for sex interaction. In contrast, the risk of hospitalization for heart failure was greater in men than women when ejection fraction was reduced (HR 1.19, 95% CI 1.07-1.33, P = .001) but not preserved (HR 0.90, 95% CI 0.67-1.22, P = .494), with P = .003 for sex interaction. The relative risk of hospitalization for worsening failure between reduced and preserved ejection fraction was greater in men than women (HR 5.97, 95% CI 1.40-25.56, P = .001 in men vs HR 2.65, 95% CI 0.68-10.31, P = .159 in women).

Conclusion

A survival advantage for women was seen in heart failure with reduced or preserved ejection fraction. In contrast, women appeared to be at lower risk for hospitalization for heart failure only when left ventricular systolic dysfunction was present.

Section snippets

Patients and study design

This study was based on a retrospective analysis of patients enrolled in the DIG trial.11 Primary study outcomes were all-cause mortality and hospitalization for worsening heart failure, and secondary end points included all-cause hospitalization and cardiovascular hospitalization.

Statistical analysis

The principal statistical analysis of the study evaluated sex as an independent predictor of survival or risk of hospitalization for worsening heart failure in all patients and in both preserved and reduced ejection

Baseline characteristics

The clinical characteristics of the 7778 patients in the analysis are compared by sex and left ventricular ejection fraction group in Table I. Female sex was significantly more common in patients with preserved compared to reduced ejection fraction (41% vs 22%, P < .001). In both ejection fraction groups, women were significantly older, more likely to have a history of hypertension and diabetes, and less likely to have heart failure due to an ischemic etiology.

Study outcomes

In the overall study population,

Discussion

The major new findings of clinical importance in our study concern the association of sex with hospitalization in patients with chronic congestive heart failure. We found that women were less likely to be hospitalized for worsening heart failure than men in the overall study population. Because clinical characteristics (including the frequency of women) and pathophysiology differ between heart failure with reduced and preserved ejection fraction, we further analyzed the association between sex

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