Heart failure (HF) with preserved ejection fraction (HFpEF) represents 50% of the HF population. Although more common in women than men, there are limited data characterizing sex differences in the management and outcomes of HFpEF patients that present acutely to the emergency department (ED). Using data from the ADHERE-EM registry linked to Medicare claims, we conducted a retrospective analysis of patients presenting to the ED with acute HF. We identified patients with HFpEF (EF ≥40%) and stratified them by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and postdischarge outcomes. We compared outcomes using Cox proportional hazards models and linear mixed models. Of 4161 patients with HFpEF, 2808 (67%) were women, and were typically older and more likely to have hypertension, but less likely to have diabetes or a smoking history (all p<0.01). Women were more likely than men to present to the ED with a systolic blood pressure >140mmHg (62.5% vs. 56.4%, p=0.0001), and also had a greater presenting EF. There were no sex differences in ED therapies, adjusted 30-and 180-day all-cause mortality, in-hospital mortality, or 30-and 180-day hospital readmissions. After adjusting for covariates, women had a longer hospital LOS (0.40 days; 95% CI 0.10, 0.70; p=0.008). Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to men. We observed adjusted differences in hospital LOS, but no differences in 30-and 180-day outcomes.Key words: heart failure with preserved ejection fraction; sex differences in management; sex differences in outcomes 3 Heart failure (HF) is a major and increasing public health problem worldwide.HF affects more than 5 million Americans, leads to more than 1 million hospitalizations, and accounts for more than $30 billion in annual medical costs. 1 HF with preserved ejection fraction (HFpEF) represents approximately 50% of the HF population, and has adverse event rates similar to HF with reduced ejection fraction. 2 The emergency department (ED) is the primary setting where initial acute HF management takes place; more than 80% of acute HF patients who present to the ED are admitted. 3 Recent studies highlight differences in baseline characteristics and initial management strategies for men versus women presenting to the ED with all types of HF, including HFpEF and HF with reduced ejection fraction, 4-6 but it is unknown whether these differences hold true in the HFpEF population, and whether there are sex differences in shortand long-term outcomes in HFpEF patients following acute HF ED presentation.To address these issues, we used data from the Acute Decompensated HF National Registry Emergency Module (ADHERE-EM) database linked to Medicare claims to evaluate sex differences in patients with HFpEF that presented to the ED with acute HF, with regard to presentation, treatments, and outcomes. MethodsT h e ADHERE-EM registry enrolled patients th...

Acute heart failure (HF) is a major public health problem with substantial associated economic costs. Because most patients who present to hospitals are admitted irrespective of their level of risk, novel approaches to manage acute HF are needed, such as the use of same-day access clinics for outpatient diuresis and observation units from the emergency department. Current published data lacks a comprehensive overview of the present state of acute HF management in various clinical settings. This review summarizes the strengths and limitations of acute HF care in the outpatient and emergency department settings. Finally, a variety of innovative technologies that have the potential to improve acute HF management are discussed.

Heart failure (HF) with preserved ejection fraction (HFpEF) represents 50% of the HF population. Although more common in women than men, there are limited data characterizing sex differences in the management and outcomes of HFpEF patients that present acutely to the emergency department (ED). Using data from the ADHERE-EM registry linked to Medicare claims, we conducted a retrospective analysis of patients presenting to the ED with acute HF. We identified patients with HFpEF (EF ≥40%) and stratified them by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and postdischarge outcomes. We compared outcomes using Cox proportional hazards models and linear mixed models. Of 4161 patients with HFpEF, 2808 (67%) were women, and were typically older and more likely to have hypertension, but less likely to have diabetes or a smoking history (all p<0.01). Women were more likely than men to present to the ED with a systolic blood pressure >140mmHg (62.5% vs. 56.4%, p=0.0001), and also had a greater presenting EF. There were no sex differences in ED therapies, adjusted 30-and 180-day all-cause mortality, in-hospital mortality, or 30-and 180-day hospital readmissions. After adjusting for covariates, women had a longer hospital LOS (0.40 days; 95% CI 0.10, 0.70; p=0.008). Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to men. We observed adjusted differences in hospital LOS, but no differences in 30-and 180-day outcomes.Key words: heart failure with preserved ejection fraction; sex differences in management; sex differences in outcomes 3 Heart failure (HF) is a major and increasing public health problem worldwide.HF affects more than 5 million Americans, leads to more than 1 million hospitalizations, and accounts for more than $30 billion in annual medical costs.1 HF with preserved ejection fraction (HFpEF) represents approximately 50% of the HF population, and has adverse event rates similar to HF with reduced ejection fraction. 2 The emergency department (ED) is the primary setting where initial acute HF management takes place; more than 80% of acute HF patients who present to the ED are admitted. 3 Recent studies highlight differences in baseline characteristics and initial management strategies for men versus women presenting to the ED with all types of HF, including HFpEF and HF with reduced ejection fraction, 4-6 but it is unknown whether these differences hold true in the HFpEF population, and whether there are sex differences in shortand long-term outcomes in HFpEF patients following acute HF ED presentation.To address these issues, we used data from the Acute Decompensated HF NationalRegistry Emergency Module (ADHERE-EM) database linked to Medicare claims to evaluate sex differences in patients with HFpEF that presented to the ED with acute HF, with regard to presentation, treatments, and outcomes. MethodsT h e ADHERE-EM registry enrolled patients that...

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