Sex-related differences in chronic heart failure: a community-based study

Area of Science:

• Cardiology
• Clinical Medicine
• Sex Differences in Health

Background:

• Chronic heart failure (CHF) affects millions globally, with varying clinical presentations.
• Understanding sex-specific differences in CHF is crucial for tailored treatment strategies.
• Ejection fraction (EF) categorizes heart failure into reduced (HFrEF), mid-range (HFmrEF), and preserved (HFpEF) types.

Purpose of the Study:

• To investigate sex-based disparities in real-world heart failure outpatients across the EF spectrum.
• To determine if these sex-related differences influence heart failure therapy and patient outcomes.

Main Methods:

• A cohort of 2528 heart failure patients (2009-2015) was analyzed.
• Patients were categorized by EF: HFpEF (59%), HFmrEF (17%), and HFrEF (24%).
• Demographics, comorbidities, therapy prescriptions, and outcomes (mortality, composite events) were compared between sexes.

Main Results:

• Females were older, less obese, and had less ischemic heart disease but more renal failure and anemia.
• Therapy differences included lower ACE-I/ARB use in females with HFmrEF/HFpEF and higher MRA use in females with HFpEF.
• Unadjusted mortality was similar across sexes, but adjusted analysis revealed lower mortality in females with HFmrEF and HFpEF.
• Non-cardiac comorbidities were significant prognostic factors in females with HFpEF.

Conclusions:

• Significant sex-related differences exist in heart failure phenotypes and patient characteristics.
• While unadjusted outcomes were similar, adjusted analyses show reduced mortality risk for females in HFmrEF and HFpEF groups.
• Non-cardiac comorbidities are key determinants of prognosis in females with HFpEF, highlighting the need for sex-specific management approaches.