Abstract 2744: Sex Differences in Heart Failure with Systolic Dysfunction: A Pooled Analysis of Five Randomized Control Trials
Background: Each year, 550,000 new cases of heart failure (HF) are identified with greater than half related to systolic dysfunction. Limited data exists on sex-related differences in etiology and outcomes.
Methods: We pooled data from 11,642 patients (8,791 men and 2,851 women) randomized in 5 HF clinical trials (PRAISE, PRAISE 2, MERIT-HF, VEST, and PROMISE) to explore sex-related differences in HF etiology (ischemic vs. non-ischemic) and time to all-cause death and time to the composite of death or hospitalization. Hazard ratios (95% confidence intervals) and Kaplan-Meier survival curves were generated.
Results: Women comprised 18% of ischemic and 31% of non-ischemic HF patients, and in both groups were older, more ethnically diverse, had higher SBP, more diabetes and more severe symptoms, but smoked less and had less prior MI than men. Mean EFs were similar (24% vs. 23%), mortality was lower (18% vs. 21%), but hospitalization greater (48% vs. 45%) among women than men. Women reported NYHA class IV symptoms more commonly than men (17% vs. 14%). After adjustment, non-ischemic etiology (HR 0.80 [0.72– 0.89]) and female sex (HR 0.76 [0.69–0.85]) were associated with longer time to death. Only non-ischemic etiology (HR 0.84 [0.79 – 0.89]), but not female sex (HR 1.00 [0.95–1.07]), was associated with longer time to death or hospitalization.
Conclusion: Sex-related differences exist in HF etiology and clinical outcomes. While women have better survival, they also have more symptoms and hospitalizations during follow up. Understanding these differences may lead to the delivery of better care.