Gender Aspects on Heart Failure

Abstract: There is an increasing amount of data suggesting that there are inherent epidemiological and pathophysiological, as well as psychosocial differences between men and women with heart failure (HF). These differences may be so profound that they warrant differences in management and treatment. Furthermore women have been greatly underrepresented in clinical HF treatment trials. The major aim of the studies in the present thesis was to investigate gender aspects on heart failure in the urban population of Malmö. This thesis is based on two different studies, a retrospectively study I – Malmö Preventive Project (papers I and II) – and a prospective study II - Heart failure and women (papers III and IV), both carried out at Malmö University Hospital. Paper I: We retrospectively examined gender differences in HF incidence and mortality during approximately 22 years of follow-up, in a middle-aged, community-based population sample. We found that women had lower risk for HF, all-cause death and HF-related death. Women were on average 65.6 ± 6.1 years and men were 65.4 ± 7.3 years old at the time of the HF diagnosis. Female and male HF patients had similar mortality risk. Causes of mortality among these relatively young, unselected HF patients differed from those previously described among older HF patients. Paper II: We retrospectively examined gender differences in predictors of HF morbidity and mortality in a middle-aged, community-based population sample. We followed the subject for approximately 22 years. Although women and men shared many predictors of HF, there were several important differences between sexes. Independent predictors of developing HF were similar to the classical predictors of cardiovascular diseases among men, but differed quite substantially in this regard among women. This was also largely true for independent predictors of combined HF or all-cause death. Paper III: We prospectively assessed gender differences in survival among 930 consecutive patients (464 [49.9%] women, mean age 76.1±10.1 years), admitted to hospital with suspected or diagnosed HF. We followed the patients for approximately 4 years. Prognosis was poor among these elderly patients hospitalised with suspected or diagnosed HF. Among all patients, women had better survival, whereas both sexes had similar survival when the HF diagnosis was certified. Our findings suggest that women and men with a valid in-hospital HF diagnosis based on contemporary criteria have similar long-term survival, irrespective of LVEF, medication and all other relevant baseline variables. Paper IV: We prospectively assessed gender differences in factors related to Brain-natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and mass (LVM), and peak oxygen consumption (Peak VO2). The original patient sample consisted of 930 consecutive patients (464 [49.9%] women), admitted to hospital with suspected or diagnosed HF. Among these patients, we assessed all those who underwent echocardiography (408; 189 women and 219 men), and especially those with certified HF (221; 90 women and 131 men) according to predetermined clinical and echocardiography criteria. Among these elderly HF patients, women had lower BNP, LVM and Peak VO2, but higher LVEF, and there were some important gender differences in factors independently related to these variables. Our findings add further knowledge about gender differences in elderly HF patients.