Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis.

Pubmed ID: 22402958

Journal: European journal of heart failure

Publication Date: May 1, 2012

MeSH Terms: Humans, Male, Female, Risk Factors, Age Factors, Survival Analysis, Hypertension, Diabetes Complications, Sex Factors, Heart Failure, Prognosis, Follow-Up Studies, Survival Rate, Stroke Volume, Myocardial Ischemia

Authors: Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C, McMurray JJ, Swedberg K, Køber L, Berry C, Squire I, Doughty RN, Whalley G, Andersson B, Hall C, Richards AM, Troughton R, Lainchbury J, Berry C, Hogg K, Norrie J, Stevenson K, Brett M, McMurray J, Pfeffer MA, Swedberg K, Granger CB, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Køber L, Torp-Pedersen C, Ahmed A, Lenzen MJ, Scholte op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Swedberg K, Cleland J, Komajda M, Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Grigorian-Shamagian L, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Guazzi M, Myers J, Arena R, McAlister FA, Ezekowitz J, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Martínez-Sellés M, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Tarantini L, Faggiano P, Senni M, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Macín SM, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Bardajı A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Gonzalez-Juanatey JR, Almendral J, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A, Newton JD, Blackledge HM, Squire IB, Wright SP, Whalley GA, Doughty RN, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Freedland KE, Carney RM, Rich MW, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Tribouilloy C, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsutsui H, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Cubbon R, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Varela-Roman A, Gonzalez-Juanatey JR, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F

Cite As: Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C, McMurray JJ, Swedberg K, Køber L, Berry C, Squire I, 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 May;14(5):473-9. Epub 2012 Mar 8.

Studies:

Abstract

AIM: The aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences in prognosis between men and women. METHODS AND RESULTS: Data from 31 studies (41 949 patients; 28 052 men, 13 897 women) from the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) individual patient meta-analysis were used. We performed survival analysis to assess the association of gender with mortality, adjusting for predictors of mortality, including age, reduced or preserved ejection fraction (EF), and ischaemic or non-ischaemic aetiology. Women were older [70.5 ( standard deviation 12.1) vs. 65.6 (standard deviation 11.6) years], more likely to have a history of hypertension (49.9% vs. 40.0%), and less likely to have a history of ischaemic heart disease (46.3% vs. 58.7%) and reduced EF (62.6% vs. 81.6%) compared with men. During 3 years follow-up, 3521 (25%) women and 7232 (26%) men died. After adjustment, male gender was an independent predictor of mortality, and the better prognosis associated with female gender was more marked in patients with heart failure of non-ischaemic, compared with ischaemic, aetiology (P-value for interaction = 0.03) and in patients without, compared with those with, diabetes (P-value for interaction <0.0001). CONCLUSION: This large, individual patient data meta-analysis has demonstrated that survival is better for women with heart failure compared with men, irrespective of EF. This survival benefit is slightly more marked in non-ischaemic heart failure but is attenuated by concomitant diabetes.