Pooja Dewan1, Rasmus Rørth1,2, Valeria Raparelli3,4, Ross T Campbell1, Li Shen1, Pardeep S Jhund1, Mark C Petrie1, Inder S Anand5, Peter E Carson6, Akshay S Desai7, Christopher B Granger8, Lars Køber2, Michel Komajda9, Robert S McKelvie10, Eileen O'Meara11, Marc A Pfeffer7, Bertram Pitt12, Scott D Solomon7, Karl Swedberg13,14, Michael R Zile15, John J V McMurray1. 1. BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.D., R.R., R.T.C., L.S., P.S.J., M.C.P., J.J.V.M.). 2. Rigshospitalet Copenhagen University Hospital, Denmark (R.R., L.K.). 3. Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (V.R.). 4. Department of Experimental Medicine, Sapienza University of Rome, Italy (V.R.). 5. VA Medical Center, University of Minnesota, MN (I.S.A.). 6. Georgetown University, Washington DC Veterans Affairs Medical Center (P.E.C.). 7. Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., M.A.P., S.D.S.). 8. Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.). 9. Department of Cardiology, Hospital Saint Joseph, France (M.K.). 10. St. Joseph's Healthcare Centre, Western University, London, ON, Canada (R.S.M.). 11. Montreal Heart Institute and Université de Montreal, Quebec, Canada (E.O.). 12. Department of Internal Medicine-Cardiology, University of Michigan School of Medicine, Ann Arbor (B.P.). 13. Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.). 14. National Heart and Lung Institute, Imperial College, London (K.S.). 15. Ralph H. Johnson Veterans Administration Medical Center, Medical University of South Carolina, Charleston, SC (M.R.Z.).
Abstract
BACKGROUND: To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction. METHODS: Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial). RESULTS: Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73-0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62-0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82-1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43-0.65]; P<0.001). E/A ratio was lower in women (1.1 versus 1.2). CONCLUSIONS: There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255.
BACKGROUND: To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction. METHODS: Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial). RESULTS:Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73-0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62-0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82-1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43-0.65]; P<0.001). E/A ratio was lower in women (1.1 versus 1.2). CONCLUSIONS: There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255.
Entities:
Keywords:
coronary artery disease; death, sudden; heart failure; quality of life; sex
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