Davide Stolfo1, Alicia Uijl2, Ola Vedin3, Anna Strömberg4, Ulrika Ljung Faxén5, Giuseppe M C Rosano6, Gianfranco Sinagra7, Ulf Dahlström4, Gianluigi Savarese8. 1. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy. Electronic address: davide.stolfo@ki.se. 2. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 3. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Clinical Development, Boehringer Ingelheim, Stockholm, Sweden. 4. Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping, Sweden. 5. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. 6. Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy. 7. Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy. 8. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: gianluigi.savarese@ki.se.
Abstract
OBJECTIVES: This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum. BACKGROUND: Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials. METHODS: In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across males and females. RESULTS: Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly lower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF. CONCLUSIONS: Males and females with HF showed different characteristics across the EF spectrum. Males reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generalizability.
OBJECTIVES: This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum. BACKGROUND: Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials. METHODS: In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across males and females. RESULTS: Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly lower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF. CONCLUSIONS: Males and females with HF showed different characteristics across the EF spectrum. Males reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generalizability.
Authors: Sebastian Ingelaere; Ruben Hoffmann; Ipek Guler; Johan Vijgen; Georges H Mairesse; Ivan Blankoff; Yves Vandekerckhove; Jean-Benoit le Polain de Waroux; Bert Vandenberk; Rik Willems Journal: Int J Cardiol Heart Vasc Date: 2022-06-25
Authors: Jamie N Justice; Nicholas M Pajewski; Mark A Espeland; Peter Brubaker; Denise K Houston; Santica Marcovina; Barbara J Nicklas; Stephen B Kritchevsky; Dalane W Kitzman Journal: Geroscience Date: 2022-01-10 Impact factor: 7.581
Authors: JoAnn Trial; Rodrigo Diaz Lankenau; Aude Angelini; Jorge E Tovar Perez; George E Taffet; Mark L Entman; Katarzyna A Cieslik Journal: Geroscience Date: 2020-08-26 Impact factor: 7.713
Authors: Muhammed T Gürgöze; Onno P van der Galiën; Marlou A M Limpens; Stefan Roest; René C Hoekstra; Arne S IJpma; Jasper J Brugts; Olivier C Manintveld; Eric Boersma Journal: ESC Heart Fail Date: 2020-11-28