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Sex differences in long-term heart failure prognosis: a comprehensive meta-analysis
Weida Qiu1, Wenbin Wang1, Shiping Wu1
1Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China.
European Journal of Preventive Cardiology
|August 5, 2024
Summary
Women with heart failure (HF) have a better long-term prognosis than men, experiencing lower risks of mortality and hospitalization. This survival benefit was more significant in chronic HF cases and among participants in randomized controlled trials.
Area of Science:
- Cardiology
- Clinical Epidemiology
- Sex Differences in Medicine
Background:
- Sex differences in heart failure (HF) prognosis are debated, with limited pooled data on long-term outcomes.
- Understanding these differences is crucial for personalized HF management.
Purpose of the Study:
- To comprehensively analyze sex disparities in the long-term prognosis of heart failure.
- To investigate how age, HF course, ejection fraction, region, study period, design, and follow-up duration influence these sex differences.
Main Methods:
- A systematic review and meta-analysis of studies published from January 1990 to March 2024.
- Inclusion of 94 studies (96 cohorts) with 706,247 participants, analyzing all-cause mortality (ACM), cardiovascular mortality (CVM), and hospitalizations for HF (HHF).
- Random-effects meta-analysis to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results:
- Female HF patients exhibited a significantly lower risk of ACM (HR 0.83), CVM (HR 0.84), HHF (HR 0.94), and composite endpoints compared to males.
- The mortality benefit for women was more pronounced in chronic HF (follow-up > 2 years) and in randomized controlled trials.
- Subgroup analyses indicated significant interactions for HF course and study design (P < 0.05).
Conclusions:
- Women with heart failure generally have a better long-term prognosis than men, characterized by reduced risks of mortality and hospitalization.
- Despite underrepresentation in clinical trials, women demonstrated survival advantages, though potentially less pronounced than in real-world settings.
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