Gender-related differences in patients with acute heart failure: Management and predictors of in-hospital mortality

Aim and methodsGender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia.ResultsWomen accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p < 0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p < 0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p < 0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42 ± 15% vs 36 ± 13%, p < 0.001) and systolic blood pressure (135 ± 40 mm Hg vs 131 ± 39 mm Hg, p = 0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p < 0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p = 0.475), and its common predictors were: systolic blood pressure at admission, creatinine > 1.5 mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men.ConclusionAmong patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders.