Impact of gender on outcomes in chronic systolic heart failure

Background and aim: Understanding the influence of gender in heart failure allows for better treatment. This study described the gender differences in heart failure patients and their response to therapy. Methods: Consecutive patients (116 men vs. 52 women) from 1997 to 2002 were recruited from a single heart failure unit. Mean follow-up was 40 ± 19 months. Results: Mean age was 68 ± 12 years; left ventricular ejection fraction (LVEF) 27 ± 12%. Women had higher mean LVEF, left ventricular end-diastolic diameter, and worse New York Heart Association (NYHA) functional class at baseline compared to men, while age, body mass index, blood pressure, estimated glomerular filtration rate and other co-morbidities did not differ significantly. Fewer women remained on angiotensin-converting-enzyme inhibitors while angiotensin-II-receptor blockers use increased significantly. By the end of the study, both genders exhibited similar magnitude of improvements in LVEF, cardiac dimensions, hemodynamics and mean NYHA functional class. In multivariate analysis, NYHA functional class was the strongest predictor of mortality: patients with NYHA class III/IV at baseline had 2.4-fold increased mortality risk compared to those in NYHA class I/II (95% CI 1.09-5.51, p = 0.03). For men, functional class at baseline was the strongest predictor of mortality while for women, it was age at baseline. Conclusions: In a contemporary tertiary referral heart failure clinic, women were observed to have better LVEF, but worse NYHA functional class than men. Both genders exhibited functional and hemodynamic improvements with only minor differences in their medical therapies. Predictors of mortality differed between the genders.