Sex differences in long‐term outcomes following acute heart failure hospitalization: Findings from the Get With The Guidelines‐Heart Failure registry

Abstract

Background and AimsSex differences in long‐term outcomes following hospitalization for heart failure (HF) across ejection fraction (EF) subtypes are not well described. In this study, we evaluated the risk of mortality and re‐hospitalization among males and females across the spectrum of EF over 5 years of follow‐up following an index HF hospitalization event.MethodsPatients hospitalized with HF between 1/1/2006–12/31/2014 from the AHA's GWTG‐HF registry with available 5‐year follow‐up using Medicare Part A claims data were included. The association between sex and risk of mortality and readmission over a 5‐year follow‐up period for each HF subtype (HFrEF [EF≤40%], HFmrEF [EF 41% to 49%], and HFpEF[EF > 50%]) was assessed using adjusted Cox models. The effect modification by the HF subtype for the association between sex and outcomes was assessed by including multiplicative interaction terms in the models.Results155 670 patients (81y, 53.4% females) were included. Over 5‐years follow‐up, males and females had comparably poor survival post‐discharge; however, females (vs. males) had greater years of survival lost to HF compared with the median age‐ and sex‐matched U.S. population (HFpEF: 17.0y vs. 14.6y; HFmrEF: 17.3y vs. 15.1y; HFrEF: 17.7y vs. 14.6y). In adjusted analysis, females (vs. males) had a lower risk of 5‐year mortality (aHR 0.89, 95% CI 0.87–0.90, p < 0.001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85–0.90; Pinteraction[sex*HF subtype] = 0.04). Females (vs. males) had a higher adjusted risk of HF readmission over 5‐year follow‐up (aHR 1.06, 95% CI 1.04–1.08, p < 0.001, with the risk difference most pronounced among patients with HFpEF (aHR 1.11, 95% CI 1.07–1.14; Pinteraction[sex*HF subtype] < 0.01).ConclusionWhile females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age‐ and sex‐matched U.S. population and had a greater risk of rehospitalization over 5 years following HF hospitalization.This article is protected by copyright. All rights reserved.

Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients

“…Advances in GDMT have resulted in the potential for a >70% relative risk reduction in cardiovascular death and HF hospitalization compared with placebo, 24 yet most of these gains have not been realized with minimal improvements in mortality seen over the past 2 decades in registry populations. [25][26][27] The crux of the disconnect lies in the suboptimal initiation and titration of GDMT in HFrEF populations. Analysis of the CHAMP-HF (Change the Management of Patients With Heart Failure) registry showed that just 1% of patients were on optimal GDMT therapy and dose.…”

September 2023 at a glance: focus on acute heart failure and health status

“…2,[9][10][11][12][13] Among 155 670 patients hospitalized with HF enrolled in the American Heart Association's Get With The Guidelines-Heart Failure registry, females (vs. males) had a greater loss in survival time than the median age-and sex-matched US population and had a greater risk of rehospitalization over 5 years following HF hospitalization. 14 Effective decongestion is the main goal of short treatment of patients with acute HF. 2,10,[15][16][17][18] [20][21][22][23][24] These data and their implications for outcomes were reviewed by Packer and Butler.…”

“…Acute HF remains a turning point in the clinical history of the patients with HF, associated with a marked worsening of quality of life (QoL) and poorer outcomes 2,9–13 . Among 155 670 patients hospitalized with HF enrolled in the American Heart Association's Get With The Guidelines‐Heart Failure registry, females (vs. males) had a greater loss in survival time than the median age‐ and sex‐matched US population and had a greater risk of rehospitalization over 5 years following HF hospitalization 14 …”

Sex Disparities in Longitudinal Use and Intensification of Guideline-Directed Medical Therapy Among Patients With Newly Diagnosed Heart Failure With Reduced Ejection Fraction

“…[4][5][6] Female (compared with male) patients are less likely to have HFrEF than HF with preserved ejection fraction and are more likely to be older at the time of diagnosis. [7][8][9] Female (compared with male) patients are less likely to receive evidence-based device therapy or to undergo coronary revascularization and are more likely to receive treatments that could worsen HF. 10 Furthermore, female (compared with male) patients with HF have a higher burden of symptoms, worse health-related quality of life, higher long-term risk of readmission, and greater loss of survival time after HF hospitalization.…”

“…10 Furthermore, female (compared with male) patients with HF have a higher burden of symptoms, worse health-related quality of life, higher long-term risk of readmission, and greater loss of survival time after HF hospitalization. 7,9,11,12 Sex differences in cardiovascular pharmacotherapies among patients with coronary artery disease, 13,14 hyperlipidemia, 15 and atrial fibrillation 16,17 are well described. In a pragmatic multicenter trial of patients hospitalized for HF in Canada, female (compared with male) patients receiving usual care had a lower uptake of reninangiotensin system inhibitors and MRAs and a greater uptake of beta-blockers at 30 days after discharge.…”