Gender differences in acute congestive heart failure

Little is known about sex differences in baseline characteristics and outcomes in patients with acute congestive heart failure (CHF).

This prospective observational study evaluated gender differences among 217 consecutive patients (124 men and 93 women) presenting with acute CHF to the emergency department. The primary endpoint was all-cause mortality. Women were older, and had less pulmonary comorbidity, but more noticeable jugular venous distension, as well as higher diastolic blood pressure and troponin level at presentation. Among contributing causes of acute CHF, myocardial ischaemia and anaemia were more frequent in women. Adequate medical CHF therapy was initiated more rapidly in women. Initial resource utilisation, time to discharge, and mortality were similar. Important differences to the disadvantage of women were noted during long-term follow-up. Mean cumulative survival was 619 (95% CI, 533-705) days in women as compared with 669 (95% CI, 601-737; p = 0.0663) in men. However, after multivariate adjustment female sex was not an independent predictor of long-term mortality (hazard ratio 1.14, 95% CI, 0.68-1.90; p = 0.619). Total spending for treatment cost was 11,858 US dollars University of Basel, University Hospital, Department of Internal Medicine, Switzerland (95% CI, 8921-14794) in women compared to 15,965 US dollars (95% CI, 12328-18003; p = 0.115) in men after 1 year. Functional status was similar in women and men at 6 and 12 months.

The trend towards lower survival in women seems primarily related to higher age and other factors rather than gender itself. Female sex is not an independent predictor of long-term mortality in acute CHF.