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Gender differences in advanced heart failure: insights from the BEST study
Jalal K Ghali1, Heidi J Krause-Steinrauf, Kirkwood F Adams
1Cardiac Centers of Louisiana, Shreveport, Louisiana 71103, USA. jkgalt@shreve.net
Journal of the American College of Cardiology
|December 19, 2003
Summary
Gender significantly influences heart failure (HF) patient characteristics and prognosis. Women with nonischemic HF showed better survival, with coronary artery disease and ejection fraction predicting outcomes differently by sex.
Area of Science:
- Cardiology
- Clinical Trials
- Heart Failure Research
Background:
- Limited data exists on gender differences in heart failure (HF) due to under-representation of women in clinical trials.
- Understanding these differences is crucial for effective HF management.
Purpose of the Study:
- To investigate the influence of gender on baseline characteristics, treatment response, and prognosis in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).
Main Methods:
- Analysis of the Beta-Blocker Evaluation of Survival Trial (BEST) data, including 2,708 patients with NYHA class III/IV HF and LVEF ≤0.35.
- Comparison of baseline characteristics and outcomes between 593 women and 2,115 men over a two-year follow-up period.
Main Results:
- Significant gender disparities observed in baseline characteristics, including age, race, etiology, ejection fraction, heart rate, and laboratory values.
- Coronary artery disease and LVEF were stronger prognostic predictors in women.
- Women with nonischemic HF demonstrated a significantly better survival rate compared to men.
Conclusions:
- Substantial gender-based differences exist in HF patients with impaired LVEF.
- Prognostic variable predictive values differ between genders.
- The survival benefit for women is primarily observed in the nonischemic HF subgroup.