Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Savarese, G.; Becher, P.M.; Lund, L.H.; Seferovic, P.; Rosano, G.M.C.; Coats, A. Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovasc. Res. 2022, cvac013. [Google Scholar] [CrossRef] [PubMed]
- Arruda, V.L.; Machado, L.M.G.; Lima, J.C.; Silva, P.R.S. Trends in mortality from heart failure in Brazil: 1998 to 2019. Rev. Bras. Epidemiol. 2022, 25, E220021. [Google Scholar] [CrossRef] [PubMed]
- Rodgers, J.L.; Jones, J.; Bolleddu, S.I.; Vanthenapalli, S.; Rodgers, L.E.; Shah, K.; Karia, K.; Panguluri, S.K. Cardiovascular Risks Associated with Gender and Aging. J. Cardiovasc. Dev. Dis. 2019, 6, 19. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lloyd-Jones, D.M.; Larson, M.G.; Leip, E.P.; Beiser, A.; d’Agostino, R.B.; Kannel, W.B.; Murabito, J.M.; Vasan, R.S.; Benjamin, E.J.; Levy, D. Lifetime risk for developing congestive heart failure: The Framingham Heart Study. Circulation 2002, 106, 3068–3072. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Roger, V.L.; Weston, S.A.; Redfield, M.M.; Hellermann-Homan, J.P.; Killian, J.; Yawn, B.P.; Jacobsen, S.J. Trends in heart failure incidence and survival in a community-based pop-ulation. JAMA 2004, 92, 344–350. [Google Scholar] [CrossRef] [Green Version]
- Gerber, Y.; Weston, S.A.; Redfield, M.M.; Chamberlain, A.M.; Manemann, S.M.; Jiang, R.; Killian, J.M.; Roger, V.L. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern. Med. 2015, 175, 996–1000. [Google Scholar] [CrossRef] [Green Version]
- Tsao, C.W.; Lyass, A.; Enserro, D.; Larson, M.G.; Ho, J.E.; Kizer, J.R.; Gottdiener, J.S.; Psaty, B.M.; Vasan, R.S. Temporal Trends in the Incidence of and Mortality Associated with Heart Failure with Preserved and Reduced Ejection Fraction. JACC Hear. Fail. 2018, 6, 678–685. [Google Scholar] [CrossRef] [PubMed]
- Zhao, Z.; Wang, H.; Jessup, J.A.; Lindsey, S.H.; Chappell, M.C.; Groban, L. Role of estrogen in diastolic dysfunction. Am. J. Physiol. Heart Circ. Physiol. 2014, 306, H628–H640. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Beale, A.L.; Meyer, P.; Marwick, T.H.; Lam, C.S.; Kaye, D.M. Sex Differences in Cardiovascular Pathophysiology. Circulation 2018, 138, 198–205. [Google Scholar] [CrossRef]
- Ho, J.E.; Gona, P.; Pencina, M.J.; Tu, J.V.; Austin, P.C.; Vasan, R.S.; Kannel, W.P.; D’Agostino, R.P.; Lee, D.S.; Levy, D. Discriminating clinical features of HF with preserved vs. reduced ejection fraction in the community. Eur. Heart J. 2012, 33, 1734–1741. [Google Scholar] [CrossRef]
- Wang, X.; Vaduganathan, M.; Claggett, B.L.; Hegde, S.M.; Pabon, M.; Kulac, I.J.; Vardeny, O.; O’Meara, E.; Zieroth, S.; Katova, T.; et al. Sex Differences in Characteristics, Outcomes and Treatment Response with Dapagliflozin across the Range of Ejection Fraction in Patients with Heart Failure: Insights from DAPA-HF and DELIVER. Circulation 2022. [Google Scholar] [CrossRef]
- Butler, J.; Filippatos, G.; Siddiqi, T.J.; Ferreira, J.P.; Brueckmann, M.; Bocchi, E.; Böhm, M.; Chopra, V.K.; Giannetti, N.; Iwata, T.; et al. Effects of Empagliflozin in Women and Men with Heart Failure and Preserved Ejection Fraction. Circulation 2022, 146, 1046–1055. [Google Scholar] [CrossRef]
- Pandey, A.; Omar, W.; Ayers, C.; LaMonte, M.; Klein, L.; Allen, N.B.; Kuller, L.H.; Greenland, P.; Eaton, C.B.; Gottdiener, J.S.; et al. Sex and Race Differences in Lifetime Risk of Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction. Circulation 2018, 137, 1814–1823. [Google Scholar] [CrossRef] [PubMed]
- Stolfo, D.; Uijl, A.; Vedin, O.; Strömberg, A.; Faxén, U.L.; Rosano, G.M.C.; Sinagra, G.; Dahlström, U.; Savarese, G. Sex-Based Differences in Heart Failure Across the Ejection Fraction Spectrum: Phenotyping, and Prognostic and Therapeutic Implica-tions. JACC Heart Fail 2019, 7, 505–515. [Google Scholar] [CrossRef]
- Savarese, G.; Vedin, O.; D’Amario, D.; Uijl, A.; Dahlström, U.; Rosano, G.; Lam, C.S.P.; Lund, L.H. Prevalence and Prognostic Implications of Longitudinal Ejection Fraction Change in Heart Failure. JACC Heart Fail 2019, 7, 306–317. [Google Scholar] [CrossRef] [PubMed]
- Dewan, P.; Rørth, R.; Jhund, P.S.; Shen, L.; Raparelli, V.; Petrie, M.C.; Abraham, W.T.; Desai, A.S.; Dickstein, K.; Køber, L.; et al. Differential Impact of Heart Failure with Reduced Ejection Fraction on Men and Women. J. Am. Coll. Cardiol. 2019, 73, 29–40. [Google Scholar] [CrossRef]
- McKee, P.A.; Castelli, W.P.; McNamara, P.M.; Kannel, W.B. The Natural History of Congestive Heart Failure: The Framingham Study. N. Engl. J. Med. 1971, 285, 1441–1446. [Google Scholar] [CrossRef] [PubMed]
- Brasil. Receita Federal. Brasília. 2022. Available online: https://servicos.receita.fazenda.gov.br/Servicos/CPF/ConsultaSituacao/ConsultaPublica.asp (accessed on 11 April 2022).
- Spitaleri, G.; Zamora, E.; Cediel, G.; Codina, P.; Santiago-Vacas, E.; Domingo, M.; Lupón, J.; Santesmases, J.; Diez-Quevedo, C.; Troya, M.I.; et al. Cause of Death in Heart Failure Based on Etiology: Long-Term Cohort Study of All-Cause and Cardiovascular Mortality. J. Clin. Med. 2022, 11, 784. [Google Scholar] [CrossRef]
- Alenazy, B.; Tharkar, S.; Kashour, T.; Alhabib, K.F.; AlFaleh, H.; Hersi, A. In-hospital ventricular arrhythmia in heart failure patients: 7 year follow-up of the multi-centric HEARTS registry. ESC Hear. Fail. 2019, 6, 1283–1290. [Google Scholar] [CrossRef] [Green Version]
- Li, L.; Tu, B.; Liu, S.; Zhang, Z.; Xiong, Y.; Hu, Z.; Yao, Y. Sex differences in ventricular arrhythmias epidemiology, risk factors, and mortality in congestive heart failure. Int. J. Cardiol. 2022. [Google Scholar] [CrossRef] [PubMed]
- Oneglia, A.; Nelson, M.D.; Merz, C.N.B. Sex Differences in Cardiovascular Aging and Heart Failure. Curr. Hear. Fail. Rep. 2020, 17, 409–423. [Google Scholar] [CrossRef]
- Komukai, K.; Mochizuki, S.; Yoshimura, M. Gender and the renin-angiotensin-aldosterone system. Fundam. Clin. Pharmacol. 2010, 24, 687–698. [Google Scholar] [CrossRef]
- Ventura-Clapier, R.; Moulin, M.; Piquereau, J.; Lemaire, C.; Mericskay, M.; Veksler, V.; Garnier, A. Mitochondria: A central target for sex differences in pathologies. Clin. Sci. 2017, 131, 803–822. [Google Scholar] [CrossRef]
- Dunlay, S.M.; Roger, V.L. Gender Differences in the Pathophysiology, Clinical Presentation, and Outcomes of Ischemic Heart Failure. Curr. Hear. Fail. Rep. 2012, 9, 267–276. [Google Scholar] [CrossRef] [PubMed]
- Hsich, E.M.; Piña, I.L. Heart Failure in Women: A Need for Prospective Data. J. Am. Coll. Cardiol. 2009, 54, 491–498. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- De Bellis, A.; De Angelis, G.; Fabris, E.; Cannatà, A.; Merlo, M.; Sinagra, G. Gender-related differences in heart failure: Beyond the “one-size-fits-all” paradigm. Hear. Fail. Rev. 2019, 25, 245–255. [Google Scholar] [CrossRef]
- Ho, J.E.; Brouwers, F.P.; Enserro, D.; Shah, S.J.; Psaty, B.M.; Bartz, T.M.; Santhanakrishnan, R.; Lee, D.S.; Liu, K.; Blaha, M.J.; et al. Abstract 11958: Predicting Heart Failure with Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes. Circulation 2015, 132, A11958. [Google Scholar] [CrossRef]
- Lam, C.S.; Carson, P.E.; Anand, I.S.; Rector, T.S.; Kuskowski, M.; Komajda, M.; McKelvie, R.S.; McMurray, J.J.; Zile, M.R.; Massie, B.M.; et al. Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: The Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ. Hear. Fail. 2012, 5, 571–578. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Magnussen, C.; Niiranen, T.J.; Ojeda, F.M.; Gianfagna, F.; Blankenberg, S.; Vartiainen, E.; Sans, S.; Pasterkamp, G.; Hughes, M.; Costanzo, S.; et al. Sex-Specific Epidemiology of Heart Failure Risk and Mortality in Europe: Results from the BiomarCaRE Consortium. JACC Heart Fail 2019, 7, 204–213. [Google Scholar] [CrossRef]
- Madan, N.; Itchhaporia, D.; Albert, C.M.; Aggarwal, N.T.; Volgman, A.S. Atrial Fibrillation and Heart Failure in Women. Hear. Fail. Clin. 2018, 15, 55–64. [Google Scholar] [CrossRef]
- Bibbins-Domingo, K.; Lin, F.; Vittinghoff, E.; Barrett-Connor, E.; Grady, D.; Shlipak, M.G. Renal insufficiency as an independent predictor of mortality among women with heart failure. J. Am. Coll. Cardiol. 2004, 44, 1593–1600. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Thompson, L.E.; Maddox, T.M.; Lei, L.; Grunwald, G.K.; Bradley, S.M.; Peterson, P.N.; Masoudi, F.A.; Turchin, A.; Song, Y.; Doros, G.; et al. Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report from the National Cardiovascular Data Registry (NCDR®) PINNACLE Registry. J. Am. Hear. Assoc. 2017, 6, e005801. [Google Scholar] [CrossRef]
- Martínez-Sellés, M.; Doughty, R.N.; Poppe, K.; Whalley, G.A.; Earle, N.; Tribouilloy, C.; McMurray, J.J.; Swedberg, K.; Køber, L.; Berry, C.; et al. Gender and survival in patients with heart failure: Interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis. Eur. J. Hear. Fail. 2012, 14, 473–479. [Google Scholar] [CrossRef]
- Farre, N.; Lupón, J.; Roig, E.; González-Costello, J.; Vila-Domènech, J.S.; Perez, S.; De Antonio, M.; Gonzalez, E.S.; Sánchez-Enrique, C.; Moliner, P.; et al. Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: A multicentre prospective observational study in Catalonia (Spain). BMJ Open 2017, 7, e018719. [Google Scholar] [CrossRef] [Green Version]
- Savarese, G.; Stolfo, D.; Sinagra, G.; Lund, L.H. Heart failure with mid-range or mildly reduced ejection fraction. Nat. Rev. Cardiol. 2021, 19, 100–116. [Google Scholar] [CrossRef]
- Grupper, A.; Freimark, D.; Murad, H.; Olmer, L.; Benderly, M.; Ziv, A.; Friedman, N.; Kaufman, G.; Silber, H.; Kalter-Leibovici, O. Sex related differences in the characteristics and outcomes of heart failure: A sub analysis of heart failure disease management study. Front. Cardiovasc. Med. 2022, 9, 1012361. [Google Scholar] [CrossRef]
- Koh, A.S.; Tay, W.T.; Teng, T.H.K.; Vedin, O.; Benson, L.; Dahlstrom, U.; Savarese, G.; Lam, C.S.; Lund, L.H. A comprehensive population-based characterization of heart failure with mid-range ejection fraction. Eur. J. Hear. Fail. 2017, 19, 1624–1634. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lund, L.H.; Claggett, B.; Liu, J.; Lam, C.S.; Jhund, P.; Rosano, G.M.; Swedberg, K.; Yusuf, S.; Granger, C.B.; Pfeffer, M.A.; et al. Heart failure with mid-range ejection fraction in CHARM: Characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur. J. Hear. Fail. 2018, 20, 1230–1239. [Google Scholar] [CrossRef] [PubMed]
All Patients N = 11,282 | Women N = 5026 (44.6) | Men N = 6256 (55.4) | p | |
---|---|---|---|---|
Age (Years) | 63.9 ± 14.4 | 65.1 ± 15.0 | 63.0 ± 13.8 | <0.0001 |
Ischemic CMP | 3248 (28.8) | 1126 (22.4) | 2122 (33.9) | <0.0001 |
Idiopathic CMP | 4598 (4S0.8) | 1989 (39.6) | 2609 (41.7) | <0.0022 |
Hypertensive CMP | 1934 (17.1) | 1033 (20.6) | 901 (14.4) | <0.0001 |
Valve disease | 1502 (13.3) | 878 (17.5) | 624 (10.0) | <0.0001 |
Myocardial infarction | 1670 (14.8) | 557 (11.1) | 1113 (17.8) | <0.0001 |
Diabetes | 214 (19.0) | 934 (18.6) | 1207 (19.3) | 0.427 |
CKD | 1202 (10.7) | 416 (8.3) | 786 (12.6) | <0.0001 |
Atrial fibrillation | 2241 (19.9) | 948 (18.9) | 1293 (20.7) | 0.019 |
Stroke | 512 (4.5) | 196 (3.9) | 316 (5.1) | 0.010 |
Number of comorbidities | 5378 (47.7) | 2225 (44.3) | 3153 (50.4) | <0.0001 |
N = 1 | 3372 (29.9) | 1482 (29.5) | 1890 (30.2) | 0.476 |
N = 2 | 1463 (13.0) | 556 (11.1) | 907 (14.5) | <0.0001 |
N = 3 | 446 (3.9) | 155 (3.1) | 291 (4.7) | 0.149 |
N ≥ 4 | 97 (0.8) | 32 (0.6) | 65 (1.0) | 0.489 |
PCI | 397 (3.5) | 140 (2.8) | 257 (4.1) | <0.0001 |
CABG | 884 (7.8) | 285 (5.7) | 599 (9.6) | <0.0001 |
Valve replacement | 988 (8.8) | 534 (10.6) | 454 (7.3) | <0.0001 |
Valvoplasty | 125 (1.1) | 81 (1.6) | 44 (0.7) | <0.0001 |
Pacemaker | 622 (5.5) | 339 (6.7) | 283 (4.5) | <0.0001 |
ICD | 265 (2.4) | 72 (1.4) | 193 (3.1) | <0.0001 |
CRT | 317 (2.8) | 151 (3.0) | 166 (2.7) | 0.181 |
Transplantation | 176 (1.6) | 62 (1.2) | 114 (1.8) | 0.007 |
Hospitalization | 3207 (28.4) | 1474 (29.3) | 1733 (27.7) | <0.0001 |
LVEF baseline | 45.3 ± 15.9 | 49.2 ± 16.0 | 42.3 ± 15.1 | <0.0001 |
LVEF final | 46.4 ± 15.0 | 49.9 ± 14.5 * | 43.7 ± 14.7 * | <0.0001 |
LVDD baseline | 57.7 ± 9.6 | 54.4 ± 8.8 | 60.1 ± 9.5 | <0.0001 |
LVDD final | 56.8 ± 10.0 | 53.7 ± 9.0 * | 59.3 ± 10.0 * | <0.0001 |
HFrEF | 4310 (38.2) | 1488 (29.6) | 2822 (45.1) | <0.0001 |
HFmrEF | 1826 (16.2) | 653 (13.0) | 1173 (18.8) | <0.0001 |
HFpEF | 5146 (45.6) | 2885 (57.4) | 2261 (36.1) | <0.0001 |
Death | 2300 (20.4) | 925 (18.4) | 1375 (22.0) | <0.0001 |
HFrEF N = 4310 (38.2) | HFmrEF N = 1826 (16.2) | HFpEF N = 5146 (45.6) | p | |
---|---|---|---|---|
Age (Years) | 60.2 ± 13.7 | 64.1 ± 13.5 | 66.9 ± 14.6 | <0.0001 |
Female | 1488 (34.5) | 653 (35.8) | 2885 (56.1) | <0.0001 |
Cardiomyopathy | ||||
Ischemic | 1173 (27.2) | 632 (34.6) | 1443 (28.0) | <0.0001 |
Idiopathic | 2353 (54.6) | 754 (41.3) | 1491 (29.0) | <0.0001 |
Hypertensive | 616 (14.3) | 314 (17.2) | 1004 (19.5) | <0.0001 |
Valve disease | 168 (3.9) | 126 (6.9) | 1208 (23.5) | <0.0001 |
Myocardial infarction | 667 (15.5) | 359 (19.7) | 644 (12.5) | <0.0001 |
Diabetes | 772 (17.9) | 364 (19.9) | 1005 (19.5) | 0.044 |
CKD | 544 (12.6) | 212 (11.6) | 446 (8.7) | <0.0001 |
Atrial fibrillation | 670 (15.6) | 363 (19.9) | 1208 (23.5) | <0.0001 |
Stroke | 217 (5.0) | 80 (4.4) | 215 (4.2) | 0.129 |
Number of comorbidities | 1931 (44.8) | 915 (50.0) | 2532 (49.2) | <0.0001 |
N = 1 | 1167 (27.1) | 538 (29.5) | 1667 (32.4) | 0.153 |
N = 2 | 547 (12.7) | 272 (14.9) | 644 (12.5) | <0.0001 |
N = 3 | 180 (4.2) | 82 (4.5) | 184 (3.6) | 0.157 |
N ≥ 4 | 37 (0.9) | 23 (1.2) | 37 (0.7) | 0.118 |
PCI | 114 (2.7) | 76 (4.2) | 207 (4.0) | 0.0004 |
CABG | 271 (6.3) | 173 (9.5) | 440 (8.6) | <0.0001 |
Valve replacement | 119 (2.8) | 87 (4.8) | 782 (15.2) | <0.0001 |
Valvoplasty | 6 (0.1) | 8 (0.4) | 111 (2.7) | <0.0001 |
Pacemaker | 129 (3.0) | 99 (5.4) | 394 (7.7) | <0.0001 |
ICD | 178 (4.1) | 39 (2.1) | 48 (0.9) | <0.0001 |
CRT | 258 (6.0) | 30 (1.6) | 29 (0.6) | <0.0001 |
Transplantation | 126 (2.9) | 7 (0.4) | 43 (0.8) | <0.0001 |
Hospitalization | 1148 (26.6) | 452 (24.7) | 1607 (31.2) | <0.0001 |
LVEF baseline | 28.7 ± 6.2 | 43.6 ± 2.9 | 61.3 ± 6.3 | <0.0001 |
LVEF final | 36.5 ± 12.9 * | 44.2 ± 11.3 | 56.5 ± 11.1 * | <0.0001 |
LVDD baseline | 64.8 ± 8.4 | 57.6 ± 6.5 | 51.0 ± 6.6 | <0.0001 |
LVDD final | 62.7 ± 10.4 * | 58.0 ± 7.8 * | 51.8 ± 7.4 * | <0.0001 |
Death | 1054 (24.5) | 342 (18.7) | 904 (17.6) | <0.0001 |
HFrEF N = 4310 (38.2) | HFmrEF N = 1826 (16.2) | HFpEF N = 5146 (45.6) | ||||
---|---|---|---|---|---|---|
Women N = 1488 (34.5) | Men N = 2822 (65.5) * | Women N = 653 (35.8) | Men N = 1173 (64.2) * | Women N = 2885 (56.1) | Men N = 2261 (43.9) * | |
Age (Years) | 60.7 ± 14.1 | 60.0 ± 13.5 | 64.0 ± 14.1 | 64.1 ± 13.2 | 67.5 ± 15.1 | 66.2 ± 13.9 * |
Cardiomyopathy | ||||||
Ischemic | 320 (21.5) | 853 (30.2) * | 174 (26.7) | 458 (39.1) * | 632 (21.9) | 811 (35.9) * |
Idiopathic | 847 (56.9) | 1506 (53.4) * | 295 (45.2) | 459 (39.1) * | 847 (29.4) | 644 (28.5) |
Hypertensive | 264 (17.7) | 352 (12.5) * | 130 (19.9) | 184 (15.7) * | 639 (22.2) | 365 (16.1) * |
Valve disease | 57 (3.8) | 111 (3.9) | 54 (8.3) | 72 (6.1) | 767 (26.6) | 441 (19.5) * |
Myocardial infarction | 174 (11.7) | 493 (17.5) * | 97 (14.8) | 262 (22.3) * | 286 (9.9) | 358 (15.6) * |
Diabetes | 274 (18.4) | 498 (17.7) | 199 (18.2) | 245 (20.9) | 541 (18.8) | 464 (20.5) |
CKD | 162 (10.9) | 382 (13.5) * | 67 (10.3) | 145 (12.4) | 187 (6.5) | 259 (11.5) * |
Atrial fibrillation | 166 (11.2) | 504 (17.9) * | 108 (16.5) | 255 (21.7) * | 674 (23.4) | 534 (23.6) |
Stroke | 62 (4.2) | 155 (5.5) | 23 (3.5) | 57 (4.9) | 111 (3.9) | 104 (4.6) |
Number of comorbidities | 588 (19.5) | 1343 (57.3) * | 288 (39.8) | 627 (50.2) * | 1349 (46.8) | 1183 (44.5) * |
N = 1 | 372 (25.0) | 795 (28.2) | 181 (27.7) | 357 (30.4) | 929 (32.2) | 738 (32.6) |
N = 2 | 155 (10.4) | 392 (13.9) | 79 (12.1) | 193 (16.5) | 322 (11.2) | 322 (14.2) |
N = 3 | 53 (3.6) | 127 (4.5) | 20 (3.1) | 62 (5.3) | 82 (2.8) | 102 (4.5) |
N ≥ 4 | 8 (0.5) | 29 (1.0) | 8 (1.2) | 15 (1.3) | 16 (1.6) | 21 (0.9) |
PCI | 36 (2.4) | 78 (2.8) | 19 (2.9) | 57 (4.9) * | 85 (3.0) | 122 (5.4) * |
CABG | 72 (4.8) | 199 (7.1) * | 47 (7.2) | 126 (10.7) * | 166 (5.8) | 274 (12.1) * |
Valve replacement | 35 (2.4) | 84 (3.0) | 35 (5.4) | 52 (4.4) | 464 (16.1) | 318 (14.1) * |
Valvoplasty | 1 (0.1) | 5 (0.2) | 4 (0.6) | 4 (0.3) | 76 (2.6) | 35 (1.6) * |
Pacemaker | 46 (3.1) | 83 (2.9) | 39 (6.0) | 60 (5.1) | 254 (8.8) | 140 (6.2) * |
ICD | 46 (3.1) | 132 (4.7) * | 12 (1.8) | 27 (2.3) | 14 (0.5) | 34 (1.5) * |
CRT | 124 (8.3) | 134 (4.8) * | 13 (2.0) | 17 (1.5) | 14 (0.5) | 15 (0.7) |
Transplantation | 43 (2.9) | 83 (2.9) | 1 (0.2) | 6 (0.5) | 18 (0.6) | 25 (1.1) |
Hospitalization | 381 (25.6) | 626 (22.2) | 152 (23.3) | 231 (19.7) | 941 (32.6) | 528 (23.9) * |
LVEF baseline | 29.2 ± 5.9 | 28.5 ± 6.3 * | 43.7 ± 3.0 | 43.6 ± 2.9 | 62.2 ± 6.1 | 60.1 ± 6.3 * |
LVEF final | 38.0 ± 12.9 | 35.7 ± 12.8 * | 44.7 ± 11.0 | 43.9 ± 11.5 | 58.2 ± 10.1 | 54.3 ± 11.8 * |
LVDD baseline | 62.6 ± 7.8 | 66.0 ± 8.4 * | 56.0 ± 6.1 | 58.4 ± 6.5 * | 49.4 ± 5.8 | 53.1 ± 6.8 * |
LVDD final | 60.3 ± 9.8 | 64.1 ± 10.4 * | 56.6 ± 7.5 | 58.8 ± 7.9 * | 50.0 ± 6.6 | 54.2 ± 7.6 * |
Death | 308 (20.7) | 746 (26.4) * | 120 (18.4) | 222 (18.9) | 497 (17.2) | 407 (18.0) |
Hazard Ratio | 95% Confidence Limits | Score Chi-Square | p | |||
---|---|---|---|---|---|---|
Age | 1.02 | 1.01 | 1.02 | CKD | 1302 | <0.0001 |
HCMP | 0.81 | 0.72 | 0.92 | Stroke | 340 | <0.0001 |
Valve disease | 1.65 | 1.45 | 1.87 | Diabetes | 259 | <0.0001 |
MI | 1.29 | 1.16 | 1.43 | AF | 244 | <0.0001 |
Diabetes | 2.06 | 1.88 | 2.26 | Age | 72 | <0.0001 |
Stroke | 2.49 | 2.20 | 2.81 | Valve disease | 66 | <0.0001 |
CKD | 2.76 | 2.51 | 3.03 | LVEF baseline | 57 | <0.0001 |
AF | 1.87 | 1.71 | 2.04 | MI | 37 | <0.0001 |
LVEF baseline | 0.76 | 0.72 | 0.81 | HCMP | 11 | 0.0009 |
PCI + CABG | 1.24 | 1.02 | 1.50 | PCI + CABG | 5 | 0.027 |
Hazard Ratio | 95% Confidence Limits | Score Chi-Square | p | ||||
---|---|---|---|---|---|---|---|
HFrEF | Age | 1.01 | 1.01 | 1.02 | CKD | 489 | <0.0001 |
HCMP | 0.69 | 0.57 | 0.84 | Stroke | 176 | <0.0001 | |
Valve disease | 1.51 | 1.15 | 1.98 | Diabetes | 128 | <0.0001 | |
MI | 1.28 | 1.10 | 1.49 | AF | 78 | <0.0001 | |
Diabetes | 2.08 | 1.82 | 2.38 | HCMP | 24 | <0.0001 | |
Stroke | 2.65 | 2.21 | 3.18 | Age | 23 | <0.0001 | |
CKD | 2.70 | 2.35 | 3.09 | LVEF baseline | 22 | <0.0001 | |
AF | 1.80 | 1.57 | 2.06 | MI | 7 | 0.0049 | |
LVEF baseline | 0.97 | 0.96 | 0.98 | Valve disease | 8 | 0.0031 | |
PCI + CABG | 1.24 | 1.02 | 1.50 | PCI + CABG | 5 | 0.027 | |
HFmrEF | Age | 1.02 | 1.01 | 1.03 | CKD | 245 | <0.0001 |
Valve disease | 2.00 | 1.40 | 2.86 | Diabetes | 65 | <0.0001 | |
MI | 1.78 | 1.39 | 2.27 | Stroke | 48 | <0.0001 | |
Diabetes | 2.33 | 1.86 | 2.93 | AF | 40 | <0.0001 | |
Stroke | 2.48 | 1.82 | 3.38 | MI | 20 | <0.0001 | |
CKD | 2.89 | 2.28 | 3.68 | Age | 14 | 0.0002 | |
AF | 1.94 | 1.53 | 2.45 | Valve disease | 15 | 0.0001 | |
PCI + CABG | 1.50 | 1.13 | 2.60 | PCI + CABG | 6 | 0.027 | |
HFpEF | Age | 1.03 | 1.03 | 1.04 | CKD | 565 | <0.0001 |
Valve disease | 1.88 | 1.60 | 2.20 | AF | 161 | <0.0001 | |
MI | 1.22 | 1.01 | 1.46 | Age | 120 | <0.0001 | |
Diabetes | 2.08 | 1.80 | 2.40 | Diabetes | 79 | <0.0001 | |
Stroke | 2.14 | 1.76 | 2.61 | Stroke | 64 | <0.0001 | |
CKD | 2.87 | 2.46 | 3.35 | Valve disease | 57 | <0.0001 | |
AF | 1.94 | 1.69 | 2.23 | MI | 4 | 0.0344 |
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Mansur, A.d.P.; Del Carlo, C.H.; Gonçalinho, G.H.F.; Avakian, S.D.; Ribeiro, L.C.; Ianni, B.M.; Fernandes, F.; César, L.A.M.; Bocchi, E.A.; Pereira-Barretto, A.C. Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study. Int. J. Environ. Res. Public Health 2022, 19, 16171. https://doi.org/10.3390/ijerph192316171
Mansur AdP, Del Carlo CH, Gonçalinho GHF, Avakian SD, Ribeiro LC, Ianni BM, Fernandes F, César LAM, Bocchi EA, Pereira-Barretto AC. Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study. International Journal of Environmental Research and Public Health. 2022; 19(23):16171. https://doi.org/10.3390/ijerph192316171
Chicago/Turabian StyleMansur, Antonio de Padua, Carlo Henrique Del Carlo, Gustavo Henrique Ferreira Gonçalinho, Solange Desirée Avakian, Lucas Carrara Ribeiro, Barbara Maria Ianni, Fábio Fernandes, Luiz Antonio Machado César, Edimar Alcides Bocchi, and Antonio Carlos Pereira-Barretto. 2022. "Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study" International Journal of Environmental Research and Public Health 19, no. 23: 16171. https://doi.org/10.3390/ijerph192316171