Abstract 13559: Gender Does Not Impact Post-Discharge Outcomes in Patients Hospitalized for Worsening Heart Failure with Reduced Ejection Fraction in the EVEREST Trial
Background: Women represent about half of patients hospitalized for acute heart failure (HF). However, they have traditionally been underrepresented in HF trials.
Hypothesis: Women have a better post-discharge prognosis than men after hospitalization for worsening HF with reduced ejection fraction (EF).
Methods: We performed a post-hoc analysis of the The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. EVEREST randomized 4133 patients hospitalized for worsening HF and EF ±40% to tolvaptan or placebo, in addition to standard therapy, within 48 hours of admission for a median follow-up of 9.9 months. Log rank tests and multivariate Cox regression models compared hazards of outcomes.
Results: Of the study population, 1058 (26%) were women. A comparison of baseline characteristics showed that women were older than men; more likely to have a history of hypertension and higher systolic blood pressures; less likely to have chronic kidney disease or previous myocardial infarction (MI); less likely to report prior coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and/or implantable cardioverter defibrillator (ICD) (all p < 0.001). Baseline usage of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists was similar between men and women (all p > 0.30). Despite a high event rate, there was no difference in all-cause mortality (men 27% vs. women 24%, multivariate Hazard ratio [mHR]=1.04, p=0.61) or CV mortality or HF hospitalization (men 42% vs. women 39%, mHR=1.11, p=0.10) on univariate analysis or after adjusting for baseline covariates.
Conclusions: Although EF ±40% was required for enrollment, women tended to present with characteristics closer to that expected for a population of HF patients with preserved EF. Nevertheless, outcomes were similar in men and women.
- © 2011 by American Heart Association, Inc.