SEX DIFFERENCES IN HEART FAILURE INCIDENCE AND OUTCOMES

Abstract

Heart failure (HF) contributes to 35% of total female cardiovascular mortality but remains poorly understood in women. We examined the sex differences in HF incidence, mortality and hospitalization in a population-based cohort. We conducted a retrospective cohort study in Ontario residents who were diagnosed with HF in an ambulatory setting between April 1, 2009 and March 31, 2014, using linked administrative databases. HF is captured through physician billing using a validated algorithm with high sensitivity and specificity for identifying HF events. Outcomes of interest were all-cause mortality and hospitalization at 1 year following HF diagnosis. Analyses were stratified by sex. Mortality rate in each group were calculated using Kaplan-Meier method. The relative hazard of death was assessed using Cox proportional hazard models. During the study period, a total of 90,707 patients were diagnosed with HF in an ambulatory setting (47% female). Female HF patients were more likely to be older, more frail, of lower income status, have comorbid conditions such as hypertension, hypothyroidism, anemia, dementia and depression, but are less likely to have ischemic heart disease, diabetes and alcohol abuse compared to men (Table). The age standardized mortality rate was 8.57 (95% CI, 8.12-9.04) per 100 female patients and 8.23 (95% CI, 7.89-8.58) per 100 male patients. Female sex is associated with an increased risk of death (HR 1.14, 95% CI 1.10-1.18). Age standardized 1-year hospitalization rates were 9.18 (95% CI, 8.69-9.69) per 100 person years for women and 9.59 (95% CI, 9.16-10.03) for men. We found higher rates of 1-year mortality and lower rates of hospitalization in female patients compared to male patients with incident HF. HF occurs in nearly equal frequency in men and women. Further studies should focus on sex differences in risk factors and HF management to improve outcomes in women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)