The association of long-term outcome and biological sex in patients with acute heart failure from different geographic regions

Abstract

Aims Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various regions of the world. Methods and results We analysed several AHF cohorts including GREAT registry (22 523 patients, mostly from Europe and Asia) and OPTIMIZE-HF (26 376 patients from the USA). Clinical characteristics and medication use at discharge were collected. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model with adjustment for baseline characteristics (e.g. age, comorbidities, clinical and laboratory parameters at admission, left ventricular ejection fraction). In the GREAT registry, women had a lower risk of death in the year following AHF [HR 0.86 (0.79–0.94), P < 0.001 after adjustment]. This was mostly driven by northeast Asia [n = 9135, HR 0.76 (0.67–0.87), P < 0.001], while no significant differences were seen in other countries. In the OPTIMIZE-HF registry, women also had a lower risk of 1-year death [HR 0.93 (0.89–0.97), P < 0.001]. In the GREAT registry, women were less often prescribed with a combination of angiotensin-converting enzyme inhibitors and beta-blockers at discharge (50% vs. 57%, P = 0.001). Conclusion Globally women with AHF have a lower 1-year mortality and less evidenced-based treatment than men. Differences among countries need further investigation. Our findings merit consideration when designing future global clinical trials in AHF.

Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

“…It seems to be a main particularity of HF north-African population. In fact, in the GREAT registry, women with AHF have a lower 1-year mortality unless less evidenced-based treatment than men [ 15 ]. In the Swede HF registry, after adjustments for mortality and morbidity, females had a better prognosis across the EF spectrum [ 6 ].…”

Clinical Characteristics and Outcomes of Hospitalized Patients With Heart Failure From the Large-Scale Japanese Registry Of Acute Decompensated Heart Failure (JROADHF)

“…In addition, age, gender, blood pressure, NYHA functional class, prior HF hospitalization, ischemic heart disease, aortic valve stenosis, hypertension, chronic kidney disease, ventricular arrhythmia, CRT-D, hemoglobin level, sodium level, potassium level, diuretics use, and ACEI/ ARB use at discharge were independently associated with cardiovascular death during the follow up after discharge, which is consistent with findings from previous reports. 13,25 The use of β-blockers was associated with long-term mor-istry undertaken in a similar era in Japan as JROADHF. Because the incidence and prevalence of AF increases with age, 19,20 the alteration in the proportion of etiology will be explained, at least in part, by aging of patients with HF in JROADHF.…”

“…The present study identified aortic valve stenosis as an independent predictor, which has not been reported previously as an independent predictor 21-23 because most previous HF registries or trials probably excluded valvular heart disease. Primarily, the prevalence of valvular heart diseases, especially aortic valve stenosis, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] In-hospital all-cause death -6.4 4.7…”

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…Biomarkeri su ključni za dijagnozu i procjenu prognoze u bolesnika s HF-om. Cirkulirajući biomarkeri povezani uz of treatments used, 8 and rates and time trends of readmission. 2,9,10 However, the importance of distinguishing worsening/chronic HF from new-onset HF in patients with first hospitalization has been highlighted, as patients with worsening/ chronic HF have a significantly greater comorbidity burden and higher adjusted risks of mortality and HF readmission.…”