Sex Differences in Early and Long Term Outcomes Among Patients Hospitalized with Acute Heart Failure - Data from the HFSIS (Heart Failure Survey in Israel)

Introduction: Data on the influence of sex on the prognosis of heart failure is conflicting, mainly because of the use of different end points and a heterogeneous heart failure population in most studies. Our aim was to investigate the impact of sex on both early and long-term mortality outcomes after hospitalization for acute heart failure.

Methods and results: We analyzed data of 2,328 patients who were hospitalized with acute heart failure enrolled in the multicenter national survey in Israel between March and April 2003 and followed up until December 2014. Women displayed significantly different clinical characteristics compared with men; including older age, higher frequency of HFPEF, as well as hypertensive heart disease and had lower percentage of CAD (all P<0.001). survival analysis showed that at 1 year the rate of all-cause mortality was 31% among women compared to 28% among men ( log rank P=0.19). Similarly at 10 years of follow-up mortality rates were non-significantly higher among women compared to men ( 87% Vs. 83%,log rank P=0.28). Multivariate cox analysis showed that renal dysfunction, older age, digoxin at discharge, and severe heart failure are independent predictors of 1year as well as 10 year all-cause mortality among women.

In men an association with 1 year mortality was found for the same predictors as in women. However at 10 year of follow-up other important independent predictors of mortality were: diabetes mellitus, low admission systolic blood pressure, low hemoglobin, and past cerebrovascular accident.

Conclusions: There are important differences in the clinical characteristics between women and men hospitalized with acute heart failure. However there were no significant differences in short and long term all-cause mortality outcome. Independent predictors of 1 year mortality were almost the same among men and women. However there were important differences in predictors of mortality at 10 years.