Sex‐ and Race‐Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction

Abstract

BackgroundSex and race have emerged as important contributors to the phenotypic heterogeneity of heart failure with preserved ejection fraction (HFpEF). However, there remains a need to identify important sex‐ and race‐related differences in characteristics and outcomes using a nationally representative cohort.Methods and ResultsData were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project—Nationwide Inpatient Sample files between 2008 and 2012. Hospitalizations with a diagnosis of HFpEF were included for analysis. Demographics, hospital characteristics, and age‐adjusted comorbidity prevalence rates were compared between men and women and whites and blacks. In‐hospital mortality was determined and compared for each subgroup. Multivariable regression analyses were used to identify and compare correlates of in‐hospital mortality for each subgroup. A sample of 1 889 608 hospitalizations was analyzed. Men with HFpEF were slightly younger than women with HFpEF and had a higher Elixhauser comorbidity score. Men experienced higher in‐hospital mortality compared with women, a finding that was attenuated after adjusting for comorbidity. Blacks with HFpEF were younger than whites with HFpEF, with lower rates of most comorbidities. Hypertension, diabetes, anemia, and chronic renal failure were more common among blacks. Blacks experienced lower in‐hospital mortality compared with whites, even after adjusting for age and comorbidity. Important correlates of mortality among all 4 subgroups included pulmonary circulation disorders, liver disease, and chronic renal failure. Atrial fibrillation was an important correlate of mortality only among women and blacks.ConclusionsDifferences in patient characteristics and outcomes reinforce the notion that sex and race contribute to the phenotypic heterogeneity of HFpEF.

Sex differences in circulating proteins in heart failure with preserved ejection fraction

“…We found several clinical variables associated with female subjects with HFpEF: higher heart rate, higher total cholesterol, lower hemoglobin, absence of CAD, no prior HF hospitalizations, and not smoking. These findings are in agreement with previous studies [ 6 , 19 , 20 ]. Although previously shown for acute HF patients [ 21 ], an association between female sex and higher cholesterol levels in HFpEF has thus far not been reported.…”

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

“…31 Conversely, in some cohort studies, female HFpEF patients represented only 48-50% of the entire HFpEF patient population. The total number of HFpEF patients enrolled in the Ibaraki Cardiovascular Assessment Study registry and the number of all-cause deaths and cardiovascular death events were not large.…”

“…In general, female HFpEF patients have occupied two thirds of the entire HFpEF study population. 31 Conversely, in some cohort studies, female HFpEF patients represented only 48-50% of the entire HFpEF patient population. 32,33 Similarly, in our sample, there was a lower number of women (46%) enrolled, which is in contrast with the epidemiology of HFpEF in the real-world setting.…”

Heart failure with preserved ejection fraction after the PARAGON-HF trial results: current knowledge and future directions

“…The association between atrial fibrillation and HF hospitalization was stronger in women (HR 1.63, 95% CI 1.40-1.91) than in men (HR 1.37, 95% CI 1.18-1.58; P-interaction = 0.03). Also Goyal et al confirmed that atrial fibrillation is an important variable in HFpEF only in women [21]. In the PARAGON-HF, 81% of women had a history of atrial fibrillation or presence of atrial fibrillation or atrial flutter on screening [9].…”

“…Other key issues are sex differences, common in patients with HFpEF [21]. Some researchers report a less pronounced effect of ACE inhibitors in women than in men with HF [22,23].…”