Sex-based differences in heart failure management and outcomes: Insights from the French-DataHF cohort

Heart failure (HF) prognosis is influenced by demographic, clinical, and healthcare-related factors, with sex playing a crucial role. However, sex-based differences in HF management and outcomes remain insufficiently characterized in real-world settings. This study aimed to assess sex-related disparities in HF prognosis and management using a comprehensive nationwide cohort.

This study utilized the French-DataHF cohort, including all French patients diagnosed with HF in the previous 5 years and alive on 1 January 2020. Inverse probability weighting (IPW) was applied to adjust for baseline differences in assessing prognosis and management. The primary outcome was all-cause mortality (ACM), while secondary outcomes included HF hospitalization and their composite. Survival analyses were performed using Cox proportional hazards models, adjusted for demographic, clinical, and healthcare factors. The study included 655 919 patients (48% female). One-year ACM was 16.8% in females vs. 15.1% in males. In IPW-adjusted analyses, females received less renin-angiotensin system inhibitors (52.8% vs. 61.5%), while a higher proportion had no annual cardiology follow-up (33.8% vs. 27.9%). In the fully adjusted model, females had a 21% lower ACM risk (adjusted hazard ratio [aHR] 0.79, 95% confidence interval [CI] 0.79-0.80) and a 15% lower composite outcome risk (aHR 0.85, 95% CI 0.85-0.86). Cardiology follow-up was associated with lower ACM risk across sexes, with adjusted risk differences ranging from 21% for one consultation to 41% for ≥4 consultations.

While females had a better-adjusted prognosis, disparities in guideline-directed medical therapy utilization and cardiology follow-up nonetheless persist. Enhancing access to specialized care for women with HF could further optimize outcomes and reduce mortality.