Gender-related dissociation in outcomes in chronic heart failure: reduced mortality but similar hospitalization in women.

Pubmed ID: 19939481

Pubmed Central ID: PMC2888923

Journal: International journal of cardiology

Publication Date: April 1, 2011

Affiliation: University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.

MeSH Terms: Humans, Male, Adult, Female, Aged, Aged, 80 and over, Cohort Studies, Middle Aged, Sex Factors, Chronic Disease, Heart Failure, Hospitalization, Treatment Outcome, Young Adult, Follow-Up Studies, Survival Rate

Grants: R01 HL085561, R01-HL085561, R01 HL085561-04, R01 HL097047, R01 HL097047-01, R01-HL097047

Authors: Ahmed MI, Love TE, Aban I, Aronow WS, Ahmed A, Mujib M, Bittner V, Lainscak M, Piña IL

Cite As: Ahmed MI, Lainscak M, Mujib M, Love TE, Aban I, Piña IL, Aronow WS, Bittner V, Ahmed A. Gender-related dissociation in outcomes in chronic heart failure: reduced mortality but similar hospitalization in women. Int J Cardiol 2011 Apr 1;148(1):36-42. Epub 2009 Nov 24.



BACKGROUND: The impact of gender on major natural history endpoints in heart failure (HF) has not been examined in a propensity-matched study. METHODS: Of the 7788 chronic systolic and diastolic HF patients in the Digitalis Investigation Group trial 1926 were women. Propensity scores for female gender were used to assemble a cohort of 1669 pairs of men and women who were well-balanced on 32 measured baseline characteristics. Matched hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with female gender were calculated using stratified Cox regression models. RESULTS: All-cause mortality occurred in 36% (rate, 1256/10,000 person-years) and 30% (rate, 1008/10,000 person-years) of matched men and women respectively during 5 years of follow up (HR when women were compared with men, 0.82, 95% CI, 0.72-0.94, P=0.004). Female gender was also associated with reduced cardiovascular mortality (matched HR, 0.85; 95% CI, 0.73-0.99, P=0.037) and a trend toward reduced non-cardiovascular mortality (matched HR, 0.73; 95% CI, 0.53-1.00; P=0.053). All-cause hospitalization occurred in 67% (rate, 4003/10,000 person-years) and 65% (rate, 3762/10,000 person-years) matched male and female patients respectively (HR for women, 1.03, 95% CI, 0.93-1.15, P=0.538). Female gender was not associated with cardiovascular or HF hospitalization but was associated with hospitalization due to unstable angina pectoris (matched HR, 1.38; 95%CI, 1.11-1.72; P=0.003) and stroke (matched HR, 0.65; 95%CI, 0.46-0.92; P=0.014). CONCLUSIONS: In patients with chronic HF, female gender has a significant independent association with improved survival but has no association with all-cause, cardiovascular, or HF hospitalizations.