Predictor Of Death In Women Research Articles

Heart rate and prognosis of heart failure with reduced ejection fraction in women and men in sinus rhythm

Abstract Background Resting heart rate (HR) is a well-established therapeutic target for treating heart failure (HF). Beta-blockers are the primary drugs to reduce HR. Elevated HR is associated with higher mortality in heart failure with reduced ejection fraction (HFrEF). However, the influence of HR on mortality and predictors of death in women with HFrEF in sinus rhythm is not well understood. Purpose to analyse mortality for HR ≤60>bpm and ≤70>bpm in women and men. Methods From February 2017 to January 2022, we analysed the influence of resting HR (≤60> and ≤70>bpm) on mortality and predictors of death in women and men with HFrEF in sinus rhythm. Baseline data included clinical characteristics and echocardiographic findings. The HR used in the analysis was obtained at the closest outpatient visit to the death event. We used the adjustment for multiple comparisons for the log-rank test of Kaplan-Meier (K-M) and Cox proportional hazards methods to analyse mortality rates and search for death predictors for women and men. Results We analysed 2,984 patients, with a mean age of 61 ± 13.8 years, 1,922 (64.4%) men. Age, body mass index, myocardial infarction, diabetes, chronic kidney disease, stroke, carvedilol dosage, hospitalization, and initial left ventricular ejection fraction (LVEF) were similar in both genders. Over the follow-up period of 3.7±1.6 years, we observed an increase in LVEF in men (29.5%±6.7% vs. 36.7%±12.9%; p<0.001) and women (29.9%±6.4 vs. 38.0%±13.4%; p<0.001), and HR reduced in men (73.1±13.0 to 72.1±11.8 bpm; p=0.007) and women (72.8±12.7 to 71.8±11.3 bpm; p=0.026). Death incidence was higher in men (43.7% vs. 36.7%; p<0.001). The cumulative incidence of death was higher in men with HR>60bpm (K-M: log-rank p<0.001) and >70bpm (K-M: log-rank p=0.011) compared to women. Cox regression for death, adjusted for covariates with p<0.25, showed age (HR=1.01;95%CL:1.008-1.017; p<0.001), men (HR=0.80;95%CL:0.71-0.90; p<0.001), LVEF (HR=0.986;95%CL:0.98-0.99; p=0.001), and HR (HR=1.005;95%CL:1.00-1.01; p=0.025) as independent death variables. For men, the independent variables were age (HR=1.01;95%CL:1.01-1.02; p=0.002), LVEF (HR=0.98;95%CL:0.97-0.99; p=0.001), and HR (HR=1.008;95%CL:1.00-1.01; p=0.008), and for women, only the age (HR=1.02;95%CL:1.01-1.02; p<0.001). Conclusion Increased HR was an independent variable of death in men but not in women. Future studies are needed to determine the best reference HR for a chronotropic drug intervention to reduce mortality in women with HFrEF in sinus rhythm.

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Mortality and predictors of death in women and men with congestive heart failure due to ischemic and nonischemic cardiomyopathy

Abstract Background Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Studies have shown that women have better survival than men, despite the higher number of hospitalizations among women. However, little is known about differences in mortality and predictors of death in women and men with heart failure due to ischemic (iCMP) and nonischemic (niCMP) cardiomyopathy. Purpose To analyze the mortality and predictors of death in women and men with iCMP and niCMP cardiomyopathy. Methods From February 2017 to September 2020, we analyzed mortality and predictors of death in women and men with CHF by iCMP and niCMP. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method and Cox proportional hazards methods to analyze mortality rates in women and men. We used the Score Chi-Square of Cox regression to search for death predictors for women and men. Results We studied 7,487 patients, mean age of 64.3 ± 14.2 years, 4,417 (59%) males. Women with iCMP and niCMP had, respectively, higher mean age (p<0.0001), higher mean left ventricular ejection fraction (LVEF) (p<0.001), and smaller left ventricular diastolic diameter (LVDD) (p< 0.001). The mean dose of carvedilol was similar in both genders for iCMP and niCMP. Over a 3-year follow-up period, 420 (15.7%) men and 325 (14.7%) women with niCMP died (p=NS), and in iCMP, 519 (29.8%) men and 211 men died. (24.5%) women (p=0.004). Higher mortality was observed in women with iCMP compared to men with iCMP (p<0.0001). The cumulative incidence of death was higher in men (K-M: log-rank p<0.0001) with iCMP, but similar for niCMP (Figure). Cox regression for death adjusted for age, sex, previous myocardial infarction (MI), diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), HF phenotype (systolic, diastolic, or mildly reduced ejection fraction), and LVEF showed that CKD, AF, diabetes, stroke, LVEF, and age, in descending order of Score Chi-Square, were the main predictors of death for niCMP and CKD, stroke, diabetes, AF, LVEF, age, and MI for iCMP. Conclusions Women had a better prognosis than men in iCMP, but similar mortality in niCMP. Gender was not an independent variable of death. Secondary prevention of cardiovascular events from the main predictors of death can significantly reduce the death rate in women and men with CHF by iCMP and niCMP.

Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study

Heart failure (HF) is one of the leading causes of death worldwide. Studies show that women have better survival rates than men despite higher hospitalizations. However, little is known about differences in mortality and predictors of death in women and men with HF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). From February 2017 to September 2020, mortality and predictors of death were analyzed in women and men with HF. Baseline data included clinical characteristics and echocardiographic findings. A total of 11,282 patients, 63.9 ± 14.4 years, including 6256 (55.4%) males, were studied. Females were older, had a higher baseline mean left ventricular ejection fraction (LVEF) and lower left ventricular diastolic diameter. During follow-ups, 1375 (22%) men and 925 (18.4%) women died. Cumulative incidence of death was higher in men with HFrEF but similar for HFmrEF and HFpEF. Cox regression for death showed renal dysfunction, stroke, diabetes, atrial fibrillation, age, LVEF, valve disease, MI, and hypertensive CMP as independent death predictors for all HF patients. Women had a better prognosis than men in HFrEF and similar mortality for HFmrEF and HFpEF, but sex was not an independent predictor of death for all HF subtypes.

Mortality and predictors of death in women and men with congestive heart failure with preserved, mildly reduced, and reducedejection fraction

Abstract Background Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, little is known about differences in mortality and predictors of death in women and men with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). Methods From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men. Results We studied 12,015 patients, mean of 63.8±14.3 years, 6637 (55%) males. Females were older (64.9±14.8 vs. 62.8±13.8 years; p<0.0001), had a higher baseline mean left ventricular ejection fraction (LVEF) (49.8±18.9% vs. 42.6±15.4%; p<0.001), and a lower left ventricular diastolic diameter (LVDD) (54.1±9.0 vs. 60.1±9.6 mm; p<0.001). Over a 3-years follow-up period, 1543 (23.2%) men and 1051 (19.5%) women of the cohort died (K-M: log-rank p<0.0001). Cumulative incidence of death was higher in men (K-M: log-rank p=0.0002) with HFrEF but similar for HFmrEF and HFpEF (Figure 1). Cox regression for death adjusted for age, ischemic, idiopathic, hypertension, Chagas, valve, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, and LVEF showed that CKD, previous stroke, and diabetes were the main predictors of death for all phenotypes of LVEF in women and men. Conclusion Women had a better prognosis than men inHFrEF but similar mortality for HFmrEF and HFpEF. Control of diabetes and preventing stroke and CKD could significantly reduce the death rate in women and men with all CHF phenotypes. Funding Acknowledgement Type of funding sources: None.

Mortality and predictors of death in women and men with congestive heart failure of different types of cardiomyopathies

Abstract Background Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, there is evidence of a gender-associated risk of dying of heart failure of different types of cardiomyopathies (CMP). Purpose To analyze the mortality of CHF due to different types of CMP in women and men Methods From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria) in five types of CMP (ischemic, idiopathic, hypertensive, Chagas, and valve disease). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses used the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men for each CMP. Results We studied 12,015 patients, mean of 63.8±14.3 years, 6637 (55%) males. For all patients, death occurred in 27.5%, 15.3%, 17.5%, 40.1%, and 24.4%, respectively, for ischemic, idiopathic, hypertensive, Chagas, and valve CMPs (p<0.0001). HFrEF was more prevalent in idiopathic (51.2%) and Chagas (49.9%), and for HFpEF valve disease (80.4%), hypertensive (51.9%), and ischemic (44.4%). Compared to men, women were older, had a higher baseline mean left ventricular ejection fraction (LVEF), and a lower left ventricular diastolic diameter (LVDD) for all five types of CMP (p<0,001). Over a 3-years follow-up period, the cumulative incidence of death was higher in men with ischemic CMP (38% vs. 31%; p=0.037) and Chagas CMP (48% vs. 38%; p<0,001) but similar for idiopathic, hypertensive, and valve disease CMP (figure). Cox regression analysis for death, for each CMP, adjusted for confounders such as age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), any cardiac surgery, cardiac pacemakers, and LVEF showed that men were an independent predictor of death only for Chagas CMP (HR=1,28; 95% CI: 1.08–1.43; p=0.009). Conclusion Men were at a higher risk of death in ischemic and Chagas CMP but not for idiopathic, hypertensive, and valve CMP. The other main predictors of death were similar for all types of CMP, namely CKD, stroke, diabetes, and AF. Funding Acknowledgement Type of funding sources: None.

Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study.

ObjectiveMale sex is one of the determinants of severe coronavirus diseas-e-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19.MethodsWe performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation (IMV), death, intensive care unit (ICU) admission and home discharge at day 7 (D7) or day 28 (D28)) in 2380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736).ResultsThe study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR: 0.66 (0.49–0.88)), death (OR: 0.49 (0.30–0.79)) and ICU admission (OR: 0.57 (0.43–0.77)) at D7 but only with ICU admission (OR: 0.58 (0.43–0.77)) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, C-reactive protein (CRP), aspartate amino transferase (AST) and estimated glomerular filtration rate (eGFR), according to the CKD-EPI formula predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only.ConclusionsIn patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.

Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans

ObjectivesDetermine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system.DesignCase series study.Setting and participantsSequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020.Measures and outcomesMeasures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death.ResultsWe included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI ≥ 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5–4.3) and IMV (aOR, 1.8; 95%CI, 1.2–3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2–2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3–5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4–4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7–7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7–19.5), IMV (aOR, 6.5; 95%CI, 2.1–20.4), and death (aOR, 4.5; 95%CI, 1.2–16.4) in men only.ConclusionsThis study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.

Immunological predictors of antenatal fetal death in women with twin-twin transfusion syndrome after application of fetoscopic laser coagulation of placental anastomoses

Immunological predictors of antenatal fetal death in women with twin-twin transfusion syndrome after application of fetoscopic laser coagulation of placental anastomoses

Myocardial Perfusion Imaging Is a Strong Predictor of Death in Women

We sought to assess the prognostic value and risk classification improvement using contemporary single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) to predict all-cause mortality. Myocardial perfusion is a strong estimator of prognosis. Evidence published to date has not established the added prognostic value of SPECT-MPI nor defined an approach to detect improve classification of risk in women from a developing nation. A total of 2,225 women referred for SPECT-MPI were followed by a mean period of 3.7 ± 1.4 years. SPECT-MPI results were classified as abnormal on the presence of any perfusion defect. Abnormal scans were further classified as with mild/moderate reversible, severe reversible, partial reversible, or fixed perfusion defects. Risk estimates for incident mortality were categorized as <1%/year, 1% to 2%/year, and >2%/year using Cox proportional hazard models. Risk-adjusted models incorporated clinical risk factors, left ventricular ejection fraction (LVEF), and perfusion variables. All-cause death occurred in 139 patients. SPECT-MPI significantly risk stratified the population; patients with abnormal scans had significantly higher death rates compared with patients with normal scans, 13.1% versus 4.0%, respectively (p < 0.001). Cox analysis demonstrated that after adjusting for clinical risk factors and LVEF, SPECT-MPI improved the model discrimination (integrated discrimination index = 0.009; p = 0.02), added significant incremental prognostic information (global chi-square increased from 87.7 to 127.1; p < 0.0001), and improved risk prediction (net reclassification improvement = 0.12; p = 0.005). SPECT-MPI added significant incremental prognostic information to clinical and left ventricular functional variables while enhancing the ability to classify this Brazilian female population into low- and high-risk categories of all-cause mortality.

497 NHS Heart Failure Survey - Acute heart failure admissions in England, Wales and Northern Ireland - demographics, clinical presentation and pre-admission pharmacology

Background: The natural history of heart failure (HF) may be different in women, because of its different clinical profile, management and response to treatment. In addition, there are few and contradictory data about the prognosis of women. Our aim was to study the long-term prognosis, and its determinants, in a large population of women hospitalized with acute HF. Methods: We prospectively evaluated all patients discharged with HF diagnosis, from the cardiology department of a tertiary university hospital, between january 2002 and december 2004 (n=412). Clinical variables, blood samples and electrocardiogram were obtained previous to discharge and an echocardiography was carried out during the hospitalisation. Patients were followed during 15±9 months and all-cause mortality was registered. Results: In comparison with men, women (n=157, 38%) were older (75 [68-80] vs. 71 [59-77] years, p<0.001), with higher prevalence of arterial hypertension (71% vs. 51%, p<0.001) and previous hospitalisations due to HF (36% vs. 25%, p=0.02). Women differed in HF aetiology, with higher rate of hypertensive myocardiopathy (17% vs. 8%, p=0.006) and lower of coronary disease (34% vs. 49%, p=0.007). Women were received less treated with antiplatelets (45% vs 62%, p=0.001), betablockers (39% vs 50%, p=0.03) and statins (31% vs 45%, p=0.003). On discharge, women had lower levels of haemoglobin (12.1±1.7 vs 12.9±1.9, p<0.001), glomerular filtration rate (51.7 [25] vs 51.7 [26], p<0.001), serum creatinine (1.1[0.5] vs 1.3[0.4], p<0.001) and uric acid (7.3[2.2] vs 7.9[2.9], p=0.021). Women had higher LVEF (40%[29] vs 35%[15], p<0.001). During follow-up, 35 (23%) women died. The cumulative probability of death for women was 11%, 17% and 24% at 6, 12 and 18months, respectively, which did not differ frommen (8%, 12% and 17%, p=0.215). In Cox regression multivariate analysis, the independents predictors of death in women were age (RR 1.05 [1.01-1.10], p=0.01), anemia (OMS) (RR 1.04 [1.10-3.78], p=0.02), previous HF hospitalisation (2.10 [1.20-3.68], p=0.01) and not be treated with rennin-angiotensin system inhibitors (2.08 [1.02-4.24], p=0.04). Conclusions: Women hospitalized because HF had a different clinical profile, but its long-term prognosis was similar to men. We identify age, anaemia, previous hospitalisation because HF and no ACE inhibitors therapy as independent predictors of death in women.

Gender-Specific Risk Stratification With B-Type Natriuretic Peptide Levels in Patients With Acute Dyspnea: Insights From the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation Study

We examined whether B-type natriuretic peptide (BNP) levels allow gender-specific risk stratification in patients with acute dyspnea. B-type natriuretic peptide levels determined in patients with heart failure correlate with the severity of disease and prognosis. Gender differences in risk prediction are poorly examined. The BASEL (B-type natriuretic peptide for Acute Shortness of Breath Evaluation) Study enrolled 190 female and 262 male patients presenting with acute dyspnea. At 24 months, cumulative mortality was comparable in women and men (38% vs. 35%, p = 0.66). Cox regression analyses revealed that BNP levels >500 pg/ml indicated a 5.1-fold increase in mortality for women (95% confidence interval [CI] 3.0 to 8.5, p < 0.001) versus a 1.8-fold increase in men (95% CI 1.2 to 2.6; p = 0.007). The area under the receiver-operating characteristic curve (AUC) for BNP to predict death was significantly higher in female (AUC: 0.80, 95% CI 0.73 to 0.86) than in male patients (AUC: 0.64, 95% CI 0.57 to 0.71; p = 0.001 for the comparison of AUC(women) versus AUC(men)). Women with BNP >500 pg/ml displayed a higher mortality as compared with men with BNP >500 pg/ml (68% vs. 46%, p = 0.015). Interaction analysis showed that BNP is a stronger predictor of death in women than in men (p = 0.008). B-type natriuretic peptide plasma levels seem to be stronger predictors of death in women than in men.

Prevalence of intermittent claudication and its effect on mortality.

The prevalence of symptoms of intermittent claudication and their association with 5-year mortality were examined in a population study in Finland. A number of 5738 men and 5224 women, aged 30-59 years, from 4 geographic areas of the country were studied. According to a structured interview, 2.1% of the men and 1.8% of the women reported typical symptoms of intermittent claudication. Claudication was most prevalent in East Finland and among persons with agricultural occupations. The symptoms were more frequent in diabetics and persons with symptoms and signs of coronary heart disease (CHD) than in persons without these diseases. High serum cholesterol and smoking were associated with these symptoms but high blood pressure was not. The risk of death from cardiovascular causes was nearly 3-fold in men with claudication compared to men without claudication. Symptoms of chest pain and smoking increased significantly the mortality risk of male claudicants. The validity of symptoms was poorer in women than in men and they were also less reliable predictors of death in women. A small part of the effect of claudication on mortality was due to its association with conventional CHD risk factors. However, after adjusting for symptoms and signs of CHD, claudication had no independent effect on mortality in men.