Global Variations According to Sex in Patients Hospitalized for Heart Failure in the REPORT-HF Registry.

BACKGROUND

Previous reports suggest that risk factors, management, and outcomes of acute heart failure (AHF) may differ by sex, but they rarely extended analysis to low- and middle-income countries.

OBJECTIVES

In this study, the authors sought to analyze sex differences in treatment and outcomes in patients hospitalized for AHF in 44 countries.

METHODS

The authors investigated differences between men and women in treatment and outcomes in 18,553 patients hospitalized for AHF in 44 countries in the REPORT-HF (Registry to Assess Medical Practice With Longitudinal Observation for the Treatment of Heart Failure) registry stratified by country income level, income disparity, and world region. The primary outcome was 1-year all-cause mortality.

RESULTS

Women (n = 7,181) were older than men (n = 11,372), were more likely to have heart failure with preserved left ventricular ejection fraction, had more comorbid conditions except for coronary artery disease, and had more severe signs and symptoms at admission. Coronary angiography, cardiac stress tests, and coronary revascularization were less frequently performed in women than in men. Women with AHF and reduced left ventricular ejection fraction were less likely to receive an implanted device, regardless of region or country income level. Women were more likely to receive treatments that could worsen HF than men (18% vs 13%; P < 0.0001). In countries with low-income disparity, women had better 1-year survival than men. This advantage was lost in countries with greater income disparity (P

CONCLUSIONS

Women were less likely to have diagnostic testing or receive guideline-directed care than men. A survival advantage for women was observed only in countries with low income disparity, suggesting that equity of HF care between sexes remains an unmet goal worldwide.

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures REPORT-HF was funded by Novartis Pharma. Dr Tromp is supported by a National University of Singapore start-up grant, a tier 1 grant from the Ministry of Education, and a CS-IRG New Investigator grant from the National Medical Research Council; has received consulting or speaker fees from Daiichi-Sankyo, Boehringer Ingelheim, Roche Diagnostics, and Us2.ai; and owns patent US-10702247-B2 unrelated to the present work. Dr Angermann has received grant support, personal fees, and nonfinancial support from Abbott, AstraZeneca, Boehringer Ingelheim, Biotronik, Novartis, Novo Nordisk, Radcliffe Group, and Vifor, all outside of the submitted work; nonfinancial support from the University Hospital Würzburg and the Comprehensive Heart Failure Center Würzburg; and grant support from the German Ministry for Education and Research (BMBF). Dr Dahlstrom has received research support from AstraZeneca, Pfizer, Boehringer Ingelheim, Vifor, Roche Diagnostics, and Boston Scientific and speaker honoraria from and consultancies for AstraZeneca, Novartis, and Amgen. Dr Hassanein has received honoraria as a lecturer from Novartis, Aventis, Amgen, Merck Sharp & Dohme, AstraZeneca, and Merck. Drs Ghadanfar, Schweizer, and Obergfell are employed by Novartis. Dr Collins has received research grants from the National Institutes of Health, Agency for Healthcare Research and Quality, and Patient-Centered Outcomes Research Institute and consulting fees from Novartis, Aiphia, Boehringer Ingelheim, Siemens, and Ortho Clinical. Dr Filippatos has received research grants from the European Union, committee fees from Novartis related to REPORT-HF, and committee membership in trials and registries sponsored by Servier, BI, Medtronic, and Vifor. Dr Cleland has received grants and personal fees from Amgen, Bayer, Bristol Myers Squibb, Philips, and Torrent Pharmaceuticals; personal fees from AstraZeneca, Myokardia, Servier, Stealth Biopharmaceuticals, Sanofi, and Abbott; grants, personal fees, and nonfinancial support from Medtronic, Novartis, and Vifor; and grants and nonfinancial support from Pharmacosmos and PharmaNord. Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, and Vifor Pharma; has served as consultant or on the advisory board, steering committee, or executive committee for Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, Vifor Pharma, Novartis, Amgen, Merck, Janssen Research and Development, Menarini, Boehringer Ingelheim, Novo Nordisk, Abbott Diagnostics, Corvia, Stealth BioTherapeutics, JanaCare, Biofourmis, Darma, Applied Therapeutics, MyoKardia, Cytokinetics, WebMD Global, Radcliffe Group, and Corpus; and serves as co-founder and nonexecutive director of eKo.ai. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.