Abstract 13520: Sex Differences in Clinical Characteristics and Outcomes of Patients with Heart Failure with Preserved Ejection Fraction -A Report from the CHART-2 Study

Abstract

Background: Several studies have reported that the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) was similar to that of patients with reduced ejection fraction. However, sex differences in clinical characteristics and mortality of HFpEF patients remains to be fully elucidated. Methods: Among the 10,219 patients registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study, we examined sex differences in clinical characteristics, treatment and long-term outcome of 3,124 patients with HFpEF in stage C/D (EF≥50%, mean age 69.4 years, 34.7% female). We constructed the Kaplan-Meier curves and Cox hazard models for all-cause death to evaluate sex difference in mortality. Results: Female patients, as compared with male patients, were characterized by higher age (71.6 vs. 68.3 years, P<0.001), higher prevalence of NYHA class III/IV (14.1 vs. 7.0%, P<0.001), higher left ventricular ejection fraction (67.2 vs. 64.5%, P<0.001), and higher brain natriuretic peptide levels (106 vs. 72.9pg/ml, P<0.001). Furthermore, less female patients received beta-blockers (37.8 vs. 43.9%, P=0.001) and renin-angiotensin system inhibitors (64.7 vs. 71.8%, P<0.001) compared with males. During the median 3.2-year follow-up, 392 patients (12.5%) died. Although Kaplan-Meier curves showed that the crude mortality was comparable between males and females (hazard ratio (HR) 1.18, P=0.11), the adjusted mortality risk was significantly lower in females (HR 0.72, P=0.009) (Figure). Female patients died due to cardiovascular causes more frequently than males (53.7 vs. 39.2%, P<0.01). Conclusions: Although female HFpEF patients had comparable all-cause mortality with males, they had severer HF and higher cardiovascular mortality than males.