Abstract 12921: Contemporary Evaluation of Female Gender and Outcomes in Heart Failure With Reduced or Preserved Left Ventricular Systolic Function
Introduction: How gender influences prognosis in heart failure with reduced ejection fraction (HF-REF) compared to preserved ejection fraction (HF-PEF) in contemporary populations is not well described.
Hypothesis: In a representative community-based HF population, female gender is independently associated with better outcomes in HF-REF and HF-PEF.
Methods: Between 2005-2012, we identified adults with confirmed HF-REF or HF-PEF receiving care in Kaiser Permanente Northern California. Outcomes included death and hospitalizations for HF or any cause. We used extended Cox regression to evaluate the impact of female gender on outcomes after accounting for baseline characteristics, cardiovascular risk factors, medical history and receipt of HF and other cardiovascular therapies based on data from comprehensive electronic health records.
Results: Among 24,257 eligible adults with HF-REF or HF-PEF, 11,227 (46%) were women and 13,030 (54%) were men. At entry, women were older and more likely to have HF-PEF, hypertension, stroke/TIA, thyroid disease, depression, and low-income status. However, women were less likely to have coronary disease, peripheral arterial disease, and dyslipidemia. Compared to men, women received more calcium blockers, diuretics and NSAIDs and less aldosterone receptor blockers, statins and antiplatelet agents. Overall rates (per 100 person-years) were high for death (14.7), HF hospitalization (16.0) and any hospitalization (74.9). After adjustment for confounders and therapies received, women were less likely than men to die, a finding that was more prominent in HF-REF (adjusted HR 0.81 [0.76-0.87]) than HF-PEF (HR 0.92 [0.88-0.97]). Additionally, though women were less likely to be admitted for HF in HF-REF (HR 0.89 [0.82-0.97]), the opposite was true in HF-PEF (HR 1.09 [1.02-1.17]). No clinically meaningful adjusted difference was seen by gender for all-cause hospitalization in HF-REF or HF-PEF.
Conclusions: In a large, contemporary HF population, female gender was independently associated with lower mortality in both HF-REF and HF-PEF but differential associations for HF hospitalizations by HF type. Future research is needed to understand potential gender-specific mechanisms explaining variation in outcomes.
Author Disclosures: P. Vafaei: None. T.K. Leong: None. S. Sung: None. K.K. Lee: None. A.S. Go: Research Grant; Significant; Research grants through Dr. Go’s institution from Novartis, Sanofi and GlaxoSmithKline.
- © 2016 by American Heart Association, Inc.