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Sex-Based Differences in Heart Failure Across the Ejection Fraction Spectrum Phenotyping, and Prognostic and Therapeutic Implications
Karolinska Inst, Sweden; Azienda Sanit Univ Integrata Trieste, Italy.
Karolinska Inst, Sweden; Univ Utrecht, Netherlands.
Uppsala Univ, Sweden; Boehringer Ingelheim GmbH and Co KG, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-4259-3671
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2019 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 6, p. 505-515Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum. BACKGROUND Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials. METHODS In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across mates and females. RESULTS Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly tower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF. CONCLUSIONS Mates and females with HF showed different characteristics across the EF spectrum. Mates reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generatizabitity. (C) 2019 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2019. Vol. 7, no 6, p. 505-515
Keywords [en]
gender; heart failure with mid-range ejection fraction; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; heart failure; outcome; registry; sex
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:liu:diva-158054DOI: 10.1016/j.jchf.2019.03.011ISI: 000469047100010PubMedID: 31146874OAI: oai:DiVA.org:liu-158054DiVA, id: diva2:1329195
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-06-24

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Strömberg, AnnaDahlström, Ulf
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Division of Nursing ScienceFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDivision of Cardiovascular Medicine
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