Title : The impact of gender on prognosis in hospitalised patients with heart failure and reduced ejection fraction
Abstract:
Introduction: It is a well-knowned that important differences in heart failure patient with reduced ejection fraction (HFrEF) exist between men and women. However, the impact of gender on mortality in this category of patients has not been sufficiently studied.
Purpose: Among this study we aim to investigate the impact of gender on the prognosis of HFrEF patients to predict all-cause mortality during follow-up.
Methods: A total of 420 patients with HFrEF were admitted in our cardiology department, were examined during a period of 18 months. We divided the patients into two groups according to sex, and then analysed all-cause mortality during follow-up between the two groups, after adjustment for the various variables described in the literature.
Results: 420 patients were included in this data, 255(60.7%) were men and 165 (39.3%) were women, the mean age in men group and women group was respectively (65.3 ± 12 years old, 67.3 ± 12.66 years; p=0.549), concerning leading cardiovascular risk factors, the difference was highly significant between the two group, women presented high prevalence of hypertension.
( 55.2% vs 30.4%; p<0.001),diabetes (66.7% vs 44.8%; p<0.001),dyslipidemia (48.5 vs 29% ;p<0.001) and obesity (51.5% vs 22.7%; p<0.001) while smoking was more frequent in men group (44. 2%vs 2.4% p<0. 001), no difference was found in term of length of hospiatalisation (p=0.938) and chronic renal failure (p=0.092).As for the biomarkers ,women had lower ferritin (192.23 vs 229.63; p=0.034) and hemoglobin (12.75 vs 13.71; p=0.020).
We noted that both readmission (female=14.5% vs men=16.1%; p=0.659) and therapeutic inertia (43.5% vs 41.8%; p=0.729) were not associated to sex, and after a follow-up of 3 months, no significant difference was established between men and women respectively for the NYHA stage >2 (27.5 %vs 23.6%; p=0.348) or the average of ejection fraction (women =42.39% vs men = 38.06 %; p=0.108) (Figure1).
For the result studied and over a follow-up period of 12 months, the impact of sex in all-cause mortality between women and men did not reach statistical significance (21.8% vs 20%p=0.401). In the multivariate analysis and after adjustment for hypertension, ischemic heart disease as the etiology of heart failure, the presence or absence of therapeutic inertia and cardiogenic shock during hospitalisation, mortality was not associated with gender differences (HR=0.86 ;95%CI :0.55 ;1 .34 ;p=0.52) however it was independently associated with ischemic heart disease (HR=1.54 ;p=0.001), therapeutic inertia (HR=3.15 ;p<0.001), and cardiogenic shock (hazard ratio 1.8 ; p<0.001) (figure 2).
Conclusion: Despite the multiple sex disparities in patients with HFrEF no significant difference in all-cause mortality was noted between men and women.
