Gender difference in heart failure with preserved ejection fraction: clinical profiles, examinations, and prognosis

Factors influencing unplanned readmission within 30 days in patients with heart failure and their predictive value: a prospective study

BACKGROUND

Heart failure imposes a significant healthcare burden, with early unplanned readmissions post-discharge linked to poor outcomes. Identifying risk factors and their predictive value is crucial for targeted interventions.

OBJECTIVE

To investigate gender differences in cumulative hazard function and the factors influencing 30-day unplanned readmissions in heart failure patients, and to compare their predictive value.

METHODS

A prospective study of heart failure patients hospitalized in Beijing Hospital from October 2023 to March 2024. Patients' nutritional status was assessed using the Mini-Nutritional Assessment Scale Short Version (MNA-SF), frailty was evaluated using the Groningen Frailty Index (GFI), and the Appendicular Skeletal Muscle Mass Index (ASMI) was calculated. Multifactorial Cox regression analysis was conducted, and ROC curves were plotted for predictive modeling.

RESULTS

A total of 121 heart failure patients (60.3% males), aged (69.87 ± 11.9) years were included. With a median follow-up duration of 30 days, 25 (20.7%) patients with readmission. COX regression analysis stratified by gender showed that age, regular smoking, nutritional status, left ventricular ejection fraction(LVEF), brain natriuretic peptide(BNP), GFI, and ASMI were independent predictors of readmission within 30 days in patients with heart failure (P < 0.050). ROC curve analysis showed that age, BNP, ASMI, smoking status, LVEF, nutritional status, and GFI individually as well as in combination predicted readmission within 30 days in patients with heart failure; the joint model performed optimally, with an AUC value reaching 0.877 (95%CI 0.801 ∼ 0.952, P < 0.001), with a sensitivity of 0.920 and a specificity of 0.729.

CONCLUSION

A multifactorial approach including age, BNP, ASMI, smoking status, LVEF, nutritional status, and GFI predicts 30-day readmission risk, offering a basis for clinical intervention strategies to improve patient outcomes.

Sex differences in long-term heart failure prognosis: a comprehensive meta-analysis

AIMS

Sex differences in the long-term prognosis of heart failure (HF) remain controversial, and there is a lack of comprehensive pooling of the sex differences in outcomes of HF. This study aims to characterize the sex differences in the long-term prognosis of HF and explore whether these differences vary by age, HF course, left ventricular ejection fraction, region, period of study, study design, and follow-up duration.

METHODS AND RESULTS

A systematic review was conducted using Medline, Embase, Web of Science, and the Cochrane Library, from 1 January 1990 to 31 March 2024. The primary outcome was all-cause mortality (ACM), and the secondary outcomes included cardiovascular mortality (CVM), hospitalization for HF (HHF), all-cause hospitalization, a composite of ACM and HHF, and a composite of CVM and HHF. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. Ninety-four studies (comprising 96 cohorts) were included in the meta-analysis, representing 706,247 participants (56.5% were men; the mean age was 71.0 years). Female HF patients had a lower risk of ACM (HR 0.83; 95% CI 0.80, 0.85; I2 = 84.9%), CVM (HR 0.84; 95% CI 0.79, 0.89; I2 = 70.7%), HHF (HR 0.94; 95% CI 0.89, 0.98; I2 = 84.0%), and composite endpoints (ACM + HHF: HR 0.89; 95% CI 0.83, 0.95; I2 = 80.0%; CVM + HHF: HR 0.85; 95% CI 0.77, 0.93; I2 = 87.9%) compared with males. Subgroup analysis revealed that the lower risk of mortality observed in women was more pronounced among individuals with long-course HF (i.e. chronic HF, follow-up duration > 2 years) or recruited in the randomized controlled trials (P for interaction < 0.05).

CONCLUSION

Female HF patients had a better prognosis compared with males, with lower risks of ACM, CVM, HHF, and composite endpoints. Despite the underrepresentation of female populations in HF clinical trials, their mortality benefits tended to be lower than in real-world settings.

REGISTRATION

PROSPERO: CRD42024526100.

Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women?

PURPOSE OF REVIEW

Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different.

RECENT FINDINGS

Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases. This fact translates into worse self-perceived quality of life, with lower hospitalization and mortality rates. Moreover, paradoxically, women are less likely to receive treatment recommended by clinical practice guidelines, including revascularization and device placement. As there are not enough representative studies of this population, the reasons for these results with better prognosis and relatively benign impact in the elderly female population are unknown, which is why it is necessary to continue with research in order to obtain greater evidence of the exposed gaps.

Cardiomyopathies in Women

Heart failure affects over 2.6 million people in the United States. While women have better overall survival rates, they also suffer from higher morbidity as shown by higher rates of hospitalization and worse quality of life. Several anatomical differences in women's hearts affect both systolic and diastolic cardiac physiology. Despite these findings, women are significantly underrepresented in clinical trials, necessitating extrapolation of data from males. Because women have sex-specific etiologies of heart failure and unique manifestations in genetic-related cardiomyopathies, meaningful sex-related differences affect heart failure outcomes as well as access to and outcomes in advanced heart failure therapies in women. This review explores these gender-specific differences and potential solutions to balance care between women and men.

Sex differences in clinical characteristics and long-term outcome in patients with heart failure: data from the KorAHF registry

BACKGROUND/AIMS

Sex differences in the prognosis of heart failure (HF) have yielded inconsistent results, and data from Asian populations are even rare. This study aimed to investigate sex differences in clinical characteristics and long-term prognosis among Korean patients with HF.

METHODS

A total of 5,625 Korean patients hospitalized for acute HF were analyzed using a prospective multi-center registry database. Baseline clinical characteristics and long-term outcomes including HF readmission and death were compared between sexes.

RESULTS

Women were older than men and had worse symptoms with higher N-terminal pro B-type natriuretic peptide levels. Women had a significantly higher proportion of HF with preserved ejection fraction (HFpEF). There were no significant differences in in-hospital mortality and rate of guideline-directed medical therapies in men and women. During median follow- up of 3.4 years, cardiovascular death (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.07-1.78; p = 0.014), and composite outcomes of death and HF readmission (adjusted HR, 1.13; 95% CI, 1.01-1.27; p = 0.030) were significantly higher in men than women. When evaluating heart failure with reduced ejection fraction (HFrEF) and HFpEF separately, men were an independent risk factor of cardiovascular death in patients with HFrEF. Clinical outcome was not different between sexes in HFpEF.

CONCLUSION

In the Korean multi-center registry, despite having better clinical characteristics, men exhibited a higher risk of all-cause mortality and readmission for HF. The main cause of these disparities was the higher cardiovascular mortality rate observed in men compared to women with HFrEF.

Coagulation Disorders and Thrombotic Complications in Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is associated with multiple cardiovascular and noncardiovascular comorbidities and risk factors which increase the risk of thrombotic complications, such as atrial fibrillation, chronic kidney disease, arterial hypertension and type 2 diabetes mellitus. Subsequently, thromboembolic risk stratification in this population poses a great challenge. Since date from the large randomized clinical trials mostly include both patients with truly preserved EF, and those with heart failure with mildly reduced ejection fraction, there is an unmet need to characterize the patients with truly preserved EF. Considering the significant evidence gap in this area, we sought to describe the coagulation disorders and thrombotic complications in patients with HFpEF and discuss the specific thromboembolic risk factors in patients with HFpEF, with the goal to tailor risk stratification to an individual patient.

Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure - Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry

BACKGROUND

Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure (ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF.

METHODS AND RESULTS

We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5-9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio [HR] per additional increase in the number of medications, 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02-1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92-1.10; P=0.95).

CONCLUSIONS

Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.