Sex differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get With The Guidelines-Heart Failure registry.
Ejection fraction
Heart failure
Outcomes
Sex differences
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
14
08
2023
received:
11
07
2023
accepted:
15
08
2023
medline:
23
10
2023
pubmed:
27
8
2023
entrez:
26
8
2023
Statut:
ppublish
Résumé
Sex differences in long-term outcomes following hospitalization for heart failure (HF) across ejection fraction (EF) subtypes are not well described. In this study, we evaluated the risk of mortality and rehospitalization among males and females across the spectrum of EF over 5 years of follow-up following an index HF hospitalization event. Patients hospitalized with HF between 1 January 2006 and 31 December 2014 from the American Heart Association's Get With The Guidelines-Heart Failure registry with available 5-year follow-up using Medicare Part A claims data were included. The association between sex and risk of mortality and readmission over a 5-year follow-up period for each HF subtype (HF with reduced EF [HFrEF, EF ≤40%], HF with mildly reduced EF [HFmrEF, EF 41-49%], and HF with preserved EF [HFpEF, EF >50%]) was assessed using adjusted Cox models. The effect modification by the HF subtype for the association between sex and outcomes was assessed by including multiplicative interaction terms in the models. A total of 155 670 patients (median age: 81 years, 53.4% female) were included. Over 5-year follow-up, males and females had comparably poor survival post-discharge; however, females (vs. males) had greater years of survival lost to HF compared with the median age- and sex-matched US population (HFpEF: 17.0 vs. 14.6 years; HFrEF: 17.3 vs. 15.1 years; HFmrEF: 17.7 vs. 14.6 years for age group 65-69 years). In adjusted analysis, females (vs. males) had a lower risk of 5-year mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.87-0.90, p < 0.0001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85-0.89; p While females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age- and sex-matched US population and had a greater risk of rehospitalization over 5 years following HF hospitalization.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1544-1554Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL125247
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG067960
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD017529
Pays : United States
Informations de copyright
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
Lam CSP, Arnott C, Beale AL, Chandramouli C, Hilfiker-Kleiner D, Kaye DM, et al. Sex differences in heart failure. Eur Heart J. 2019;40:3859-3868c. https://doi.org/10.1093/eurheartj/ehz835
Stolfo D, Uijl A, Vedin O, Strömberg A, Faxén UL, Rosano GMC, et al. Sex-based differences in heart failure across the ejection fraction spectrum: Phenotyping, and prognostic and therapeutic implications. JACC Heart Fail. 2019;7:505-515. https://doi.org/10.1016/j.jchf.2019.03.011
Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: The Framingham study. Am J Cardiol. 1974;34:29-34. https://doi.org/10.1016/0002-9149(74)90089-7
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557-1562. https://doi.org/10.1001/jama.1996.03530440037034
Savji N, Meijers WC, Bartz TM, Bhambhani V, Cushman M, Nayor M, et al. The association of obesity and cardiometabolic traits with incident HFpEF and HFrEF. JACC Heart Fail. 2018;6:701-709. https://doi.org/10.1016/j.jchf.2018.05.018
Diaz-Canestro C, Pentz B, Sehgal A, Yang R, Xu A, Montero D. Lean body mass and the cardiovascular system constitute a female-specific relationship. Sci Transl Med. 2022;14:eabo2641. https://doi.org/10.1126/scitranslmed.abo2641
Pandey A, Patel KV. Sex, lean body mass, and cardiac performance. Sci Transl Med. 2022;14:eadd5297. https://doi.org/10.1126/scitranslmed.add5297
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, de Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-3241. https://doi.org/10.1093/eurheartj/ehy340
Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia: An overview. Circulation. 2014;130:703-714. https://doi.org/10.1161/CIRCULATIONAHA.113.003664
Truby LK, O'Connor C, Fiuzat M, Stebbins A, Coles A, Patel CB, et al. Sex differences in quality of life and clinical outcomes in patients with advanced heart failure: Insights from the PAL-HF trial. Circ Heart Fail. 2020;13:e006134. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006134
Adams KF Jr, Sueta CA, Gheorghiade M, O'Connor CM, Schwartz TA, Koch GG, et al. Gender differences in survival in advanced heart failure. Insights from the FIRST study. Circulation. 1999;99:1816-1821. https://doi.org/10.1161/01.cir.99.14.1816
O'Meara E, Clayton T, McEntegart MB, McMurray J, Piña IL, Granger CB, et al.; CHARM Investigators. Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation. 2007;115:3111-3120. https://doi.org/10.1161/CIRCULATIONAHA.106.673442
Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C, et al.; Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC). Gender and survival in patients with heart failure: Interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis. Eur J Heart Fail. 2012;14:473-479. https://doi.org/10.1093/eurjhf/hfs026
Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, Fonarow GC. National differences in trends for heart failure hospitalizations by sex and race/ethnicity. Circ Cardiovasc Qual Outcomes. 2017;10:e003552. https://doi.org/10.1161/CIRCOUTCOMES.116.003552
Smaha LA; American Heart Association. The American Heart Association Get With The Guidelines program. Am Heart J. 2004;148:S46-S48. https://doi.org/10.1016/j.ahj.2004.09.015
Hammill BG, Hernandez AF, Peterson ED, Fonarow GC, Schulman KA, Curtis LH. Linking inpatient clinical registry data to Medicare claims data using indirect identifiers. Am Heart J. 2009;157:995-1000. https://doi.org/10.1016/j.ahj.2009.04.002
Social Deprivation Index (SDI). https://www.graham-center.org/maps-data-tools/social-deprivation-index.html. Accessed 6 July 2023
Lund LH, Carrero JJ, Farahmand B, Henriksson KM, Jonsson Å, Jernberg T, et al. Association between enrolment in a heart failure quality registry and subsequent mortality - A nationwide cohort study. Eur J Heart Fail. 2017;19:1107-1116. https://doi.org/10.1002/ejhf.762
Pocock SJ, Wang D, Pfeffer MA, Yusuf S, McMurray JJV, Swedberg KB, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2006;27:65-75. https://doi.org/10.1093/eurheartj/ehi555
Smith DH, Thorp ML, Gurwitz JH, McManus DD, Goldberg RJ, Allen LA, et al. Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: The Cardiovascular Research Network PRESERVE Study. Circ Cardiovasc Qual Outcomes. 2013;6:333-342. https://doi.org/10.1161/CIRCOUTCOMES.113.000221
Shah S, Segar MW, Kondamudi N, Ayers C, Chandra A, Matulevicius S, et al. Supranormal left ventricular ejection fraction, stroke volume, and cardiovascular risk: Findings from population-based cohort studies. JACC Heart Fail. 2022;10:583-594. https://doi.org/10.1016/j.jchf.2022.05.007
Patel N, Chakraborty S, Bandyopadhyay D, Amgai B, Hajra A, Atti V, et al. Association between depression and readmission of heart failure: A national representative database study. Prog Cardiovasc Dis. 2020;63:585-590. https://doi.org/10.1016/j.pcad.2020.03.014
Mauricio R, Patel KV, Agusala V, Singh K, Lewis A, Ayers C, et al. Sex differences in cardiac function, biomarkers and exercise performance in heart failure with preserved ejection fraction: Findings from the RELAX trial. Eur J Heart Fail. 2019;21:1476-1479. https://doi.org/10.1002/ejhf.1554
Kaul P, Rathwell S, Lam CSP, Westerhout CM, Spertus JA, Anstrom KJ, et al.; VITALITY-HFpEF Study Group. Patient-reported frailty and functional status in heart failure with preserved ejection fraction: Insights from VITALITY-HFpEF. JACC Heart Fail. 2023;11:392-403. https://doi.org/10.1016/j.jchf.2022.11.015
Batsis JA, Mackenzie TA, Emeny RT, Lopez-Jimenez F, Bartels SJ. Low lean mass with and without obesity, and mortality: Results from the 1999-2004 National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci. 2017;72:1445-1451. https://doi.org/10.1093/gerona/glx002
van Spall H, DeFilippis EM, Lee SF, Oz UE, Perez R, Healey JS, et al. Sex-specific clinical outcomes of the PACT-HF randomized trial. Circ Heart Fail. 2021;14:e008548. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008548
Smith JR, Thomas RJ, Bonikowske AR, Hammer SM, Olson TP. Sex differences in cardiac rehabilitation outcomes. Circ Res. 2022;130:552-565. https://doi.org/10.1161/CIRCRESAHA.121.319894
Beckie TM, Beckstead JW. The effects of a cardiac rehabilitation program tailored for women on their perceptions of health: A randomized clinical trial. J Cardiopulm Rehabil Prev. 2011;31:25-34. https://doi.org/10.1097/HCR.0b013e3181f68acc
McMurray JJV, Jackson AM, Lam CSP, Redfield MM, Anand IS, Ge J, et al. Effects of sacubitril-valsartan versus valsartan in women compared with men with heart failure and preserved ejection fraction: Insights from PARAGON-HF. Circulation. 2020;141:338-351. https://doi.org/10.1161/CIRCULATIONAHA.119.044491