Sex-specific differences in disease severity and outcomes in left ventricular heart failure: a nationwide cohort...

Left ventricular heart failure (LVHF) remains a major contributor to morbidity and mortality, with sex-specific differences. This study investigates the influence of sex and New York Heart Association (NYHA) classification on clinical outcomes and healthcare costs.

We analyzed data from 2,616,462 LVHF hospitalization cases in Germany (2014-2022), sourced from the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Federal States (DESTATIS). Cases were stratified by sex and NYHA stages. Baseline characteristics, comorbidities, in-hospital outcomes, and healthcare costs were assessed. Multivariable logistic regression evaluated in-hospital survival. Women were more frequently diagnosed at earlier NYHA stages; men dominated in advanced stages. In-hospital mortality was higher among women (8.34% (108,461) vs. 7.90% (103,883)). However, stratified analyses showed higher mortality rates for men across most age and NYHA groups, except for men aged 80-89 in NYHA I, < 40 in NYHA III, and 40-59 in NYHA IV. Despite being younger and hospitalized for shorter or equal durations, men incurred higher costs in NYHA III (2,931.34 vs. 2,922.67) and NYHA IV (2,960.72 vs. 2,923.36). NYHA stage was the strongest predictor of in-hospital mortality (NYHA II: OR 1.596; NYHA III: OR 5.290; NYHA IV: OR 22.533]; all p < 0.001), while female sex (OR 0.841) and obesity (OR 0.751) were associated with lower mortality.

LVHF outcomes and costs differ by sex and NYHA stage. Though women had higher overall mortality, men showed worse outcomes in most subgroups. These findings stress the importance of sex- and stage-specific LVHF management strategies.