Sex Differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get with The Guidelines - Heart Failure Registry.
Sex Differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get with The Guidelines - Heart Failure Registry. European journal of heart failure 2023Abstract
BACKGROUND AND AIMS: 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 re-hospitalization among males and females across the spectrum of EF over 5years of follow-up following an index HF hospitalization event.METHODS: Patients hospitalized with HF between 1/1/2006-12/31/2014 from the AHA's GWTG-HF 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 (HFrEF [EF=40%], HFmrEF [EF 41% to 49%], and 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.RESULTS: 155670 patients (81y, 53.4% females) were included. Over 5-years 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 U.S. population (HFpEF: 17.0y vs. 14.6y; HFmrEF: 17.3y vs. 15.1y; HFrEF: 17.7y vs. 14.6y). In adjusted analysis, females (vs. males) had a lower risk of 5-year mortality (aHR 0.89, 95% CI 0.87-0.90, p<0.001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85-0.90; Pinteraction [sex*HF subtype]=0.04). Females (vs. males) had a higher adjusted risk of HF readmission over 5-year follow-up (aHR 1.06, 95% CI 1.04-1.08, p<0.001, with the risk difference most pronounced among patients with HFpEF (aHR 1.11, 95% CI 1.07-1.14; Pinteraction [sex*HF subtype]<0.01).CONCLUSION: While females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age- and sex-matched U.S. population and had a greater risk of rehospitalization over 5years following HF hospitalization. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/ejhf.3003
View details for PubMedID 37632339