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Sex Differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get with The Guidelines - Heart Failure Registry. European journal of heart failure Keshvani, N., Shah, S., Ayodele, I., Chiswell, K., Alhanti, B., Allen, L., Greene, S. J., Yancy, C., Alonso, W., Van Spall, H., Fonarow, G. C., Heidenreich, P. A., Pandey, A. 2023

Abstract

BACKGROUND AND AIMS: Sex differences in long-term outcomes following hospitalization for heart failure (HF) across ejection fraction (EF) subtypes are not well described. In this study, we evaluated the risk of mortality and re-hospitalization among males and females across the spectrum of EF over 5years of follow-up following an index HF hospitalization event.METHODS: Patients hospitalized with HF between 1/1/2006-12/31/2014 from the AHA's GWTG-HF registry with available 5-year follow-up using Medicare Part A claims data were included. The association between sex and risk of mortality and readmission over a 5-year follow-up period for each HF subtype (HFrEF [EF=40%], HFmrEF [EF 41% to 49%], and HFpEF[EF>50%]) was assessed using adjusted Cox models. The effect modification by the HF subtype for the association between sex and outcomes was assessed by including multiplicative interaction terms in the models.RESULTS: 155670 patients (81y, 53.4% females) were included. Over 5-years follow-up, males and females had comparably poor survival post-discharge; however, females (vs. males) had greater years of survival lost to HF compared with the median age- and sex-matched U.S. population (HFpEF: 17.0y vs. 14.6y; HFmrEF: 17.3y vs. 15.1y; HFrEF: 17.7y vs. 14.6y). In adjusted analysis, females (vs. males) had a lower risk of 5-year mortality (aHR 0.89, 95% CI 0.87-0.90, p<0.001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85-0.90; Pinteraction [sex*HF subtype]=0.04). Females (vs. males) had a higher adjusted risk of HF readmission over 5-year follow-up (aHR 1.06, 95% CI 1.04-1.08, p<0.001, with the risk difference most pronounced among patients with HFpEF (aHR 1.11, 95% CI 1.07-1.14; Pinteraction [sex*HF subtype]<0.01).CONCLUSION: While females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age- and sex-matched U.S. population and had a greater risk of rehospitalization over 5years following HF hospitalization. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/ejhf.3003

View details for PubMedID 37632339