Abstract 16872: Sex Differences in Acute Decompensated Heart Failure: A Pooled Analysis

Abstract

Introduction: Sex differences in heart failure physiology, presentation, and symptoms have been well established across the heart failure spectrum. Sex differences in presentations of acute decompensated heart failure (ADHF) have not yet been well explored. We pooled data from 5 clinical trials to assess sex-based differences in presentation of ADHF. Methods: Patient clinical variables, hemodynamic parameters, patient-reported outcomes, and clinical outcomes were compared among trial data from ATHENA, CARRESS, DOSE, ESCAPE and ROSE. Baseline characteristics, physiologic variables, and medications were compared between men and women in aggregate as well as by study. Echo and invasive hemodynamics were assessed in ESCAPE only. Correlations were assessed in a stepwise manner assess relationships between clinical parameters. We also compared weight change and net fluid balance between sexes. Results: Among 1,649 patients pooled across trials, 466 (28%) were women. Men had significantly lower LVEF, pulse pressure, systemic vascular resistance, and body mass index. Women had lower natriuretic peptide, intracardiac filling pressures and six-minute walk distance. Women had higher pulse pressure and systemic vascular resistance (Table). Women had much higher rates of LV hypertrophy (71% vs 43%, p = 0.007) using sex-specific criteria whereas men had much higher rates of anemia using sex-specific criteria. At discharge women had a lower net fluid balance and less weight loss both in absolute terms and adjusted for body weight. Conclusion: The results above demonstrate significant sex-based differences in presentation for ADHF. Despite generally similar signs and symptoms of congestion, women presented with less fluid accumulation, lower filling pressures and preserved peripheral hemodynamics. These differences suggest warning signs for ADHF and treatment goals during hospitalization may be different in women than men.