Factors related with survival in men and women with heart failure

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The study was supported by an intramural research grant from the National Institute of Cardiology. Background Heart failure (HF) is a significant cause of morbidity and mortality in both women and men. The discrepancies in the underlying mechanisms and etiology of HF in both sexes suggest that factors related to the prognosis of HF and the risk of death may also be different in men and women. Objective The aim of the study was to identify factors related with survival in men and women with HF. Methods Patients from a hospital database coded as hospitalizations for HF between 01/2014 and 05/2019 were included in the analysis. In all patients, the diagnosis of HF was verified. Information on HF, comorbidities, and death was obtained from available medical records. Kaplan-Meier survival curves were generated to analyze time-to-event data and to compare survival in both men and women. Multivariable Cox proportional hazard analysis was used to evaluate the risk of death and related factors. Results 1824 (70.1%) men and 777 (29.9%) women were included. Women were older than men (68.3 vs. 62.4 years; p<0.001). The median follow-up time (2.43 vs. 2.42 years; p=0.550), and the proportion of all deaths during follow-up were similar in men and women (37.8 vs. 34.5%; p=0.112). The Kaplan-Meier survival curves by sex were alike (p=0.2732) and are presented in Figure 1. The results of the multivariable Cox proportional hazards analysis are presented in Table 1. In both men and women respectively, after adjustment for other covariates, a significant association with an increased risk of death was documented for: catecholamines (HR=2.27 and HR=2.92), significant tricuspid regurgitation (HR=1.46 and HR=1.66), renal failure (HR=1.59 and HR=1.68), liver failure (HR=1.90 and HR=2.44), anemia (HR=1.51 and HR=1.46) and emergency admission (HR=1.21 and HR=1.77). The optimal dose of ACEI was associated with a decreased risk of death in both sexes (HR=0.75 in men and HR=0.60 in women). In men, we also found that other factors, such as diuretics (HR=2.29), chronic HF (HR=1.87), ischemic etiology (HR=1.40), atherosclerosis (HR=1.37), stroke (HR = 1.28), cardioverter defibrillator implantation (HR=1.27), ventricular arrythmias (HR=1.24), and age (HR=1.02) were related with a higher risk of death. Furthermore, only in women a higher risk of death was associated with dementia (HR=2.26), hypertension (HR=1.81), amiodarone (HR=1.68), aortic stenosis (HR=1.52), and myocardial infarction (HR=1.46), while a lower risk was found for an increasing number of comorbidities (HR=0.86). Conclusions Overall survival in men and women with HF was similar, as well as the strength and direction of the relationship with the risk of death in common risk factors. However, some of the predictors of death differed between men and women, which should draw our attention to potential differences in gender-related parameters affecting survival in HF.