Elsevier

JACC: Heart Failure

Volume 9, Issue 5, May 2021, Pages 336-345
JACC: Heart Failure

Mini-Focus Issue: Insights From Acute Heart Failure Trials
Clinical Research
Sex Differences in Clinical Course and Patient-Reported Outcomes Among Patients Hospitalized for Heart Failure

https://doi.org/10.1016/j.jchf.2020.12.011Get rights and content
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Abstract

Objectives

The goal of this study was to evaluate differences in clinical and patient-reported outcomes between women and men hospitalized for acute HF.

Background

Among patients hospitalized for heart failure (HF), it is unclear if symptom burden, response to therapy, and patient-reported quality of life (QOL) are different in women as compared with men.

Methods

The ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial randomized 7,141 patients hospitalized for HF with reduced or preserved ejection fraction (EF) to receive nesiritide or placebo in addition to standard care. Clinical endpoints included 30-day mortality and rehospitalization and 180-day mortality. Patient-reported QOL was assessed at baseline, discharge, and 30 days using the EuroQOL 5 dimensions (EQ-5D) survey.

Results

Among 7,141 total patients, 4,697 (65.8%) were men and 2,444 (34.2%) were women. Among patients with EF ≤40%, women were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and beta-blocker therapy, and less likely to have an implantable cardioverter-defibrillator (all p < 0.03). Signs and symptoms of HF were similar between men and women (all p > 0.05), but women experienced less in-hospital weight loss and urine output (all p < 0.01). In unadjusted and adjusted analyses, men and women had similar risk of all mortality and rehospitalization endpoints (all p ≥ 0.41). Women reported lower EQ-5D utility and visual analogue scores at admission, discharge, and 30 days. Women continued to have significantly lower EQ-5D scores at all in-hospital and post-discharge time points after adjustment for clinical characteristics (all p < 0.01).

Conclusions

In this acute HF population, women had similar risk of mortality and rehospitalization as compared with men, but experienced worse patient-reported QOL during and after hospitalization that persisted after adjustment for demographic and clinical factors. Current acute HF management may work similarly in either sex for purposes of preventing clinical events, but may be less equipped to improve patient-reported outcomes in women as compared with men.

Key Words

heart failure
outcomes
quality of life
women

Abbreviations and Acronyms

CI
confidence interval
EF
ejection fraction
EQ-5D
EuroQOL 5 dimensions
GDMT
guideline-directed medical therapy
HF
heart failure
HFrEF
heart failure with reduced ejection fraction
HRQOL
health-related quality of life
VAS
visual analogue scale

Cited by (0)

John Teerlink, MD, served as Guest Editor for this paper.

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