Gender disparities in the prognosis of patients with chronic inflammatory diseases admitted with acute heart failure

Background

Gender disparities in outcomes across various medical conditions have been well-documented. This study aims to evaluate gender specific differences in the prognosis of patients with chronic inflammatory diseases (CID) admitted with acute heart failure (AHF).

Methods

The National Inpatient Sample was analyzed to identify all patients admitted to US hospitals with AHF between 2016 and 2019. AHF and CID diagnoses were identified using validated ICD-10 codes. The primary endpoint was in-hospital mortality. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding events, and mean length of stay (LOS). MACCE was defined as a composite of mortality from any cause, acute ischemic stroke, and cardiac complications. Major bleeding events encompassed gastrointestinal, retroperitoneal, intracranial, or intracerebral hemorrhage, periprocedural or unspecified hemorrhage, and the need for blood transfusion.

Results

Our analysis includes 1,042,220 AHF admissions, of which 39,485 patients had a diagnosis of CID, with a mean age of 71 years. Of these, 26,770 (68%) were female. The three most common CIDs were Rheumatoid Arthritis (RA), Psoriasis, and SLE. The overall mortality rate across the cohort was 2.8%. In patients with CID, mortality rates were higher in women than men, though not statistically significant (2.9% vs. 2.6%, p=0.074). Women had significantly higher rates of MACCE (6.2% vs. 4.7%, p<0.001) and major bleeding events (1.7% vs. 1.3%, p=0.002). Conversely, mean LOS was significantly longer in men (5.8 vs. 5.5 days, p<0.001). [Figure 1].

Conclusion

Our study is the largest to investigate gender disparities among CID patients hospitalized with AHF. In this unique population, mortality rates were similar in both genders, with women suffering from higher rates of MACCE and major bleeding. These findings emphasize the need for further research into gender-specific risk factors and management strategies for this population.