Association Between Heart Failure Etiology and All-Cause Mortality with Sex-Specific Considerations: Insights from the HEROES Registry

Background: Heart failure (HF) is a complex clinical syndrome, and its prognosis depends on many factors, including its etiology and the patient’s sex. We aimed to perform gendered evaluations on ischemic etiology’s impact on HF prognosis. Methods: Hospitalized patients and outpatients were enrolled in the Heart Failure Observational Study (HEROES), which is a prospective, multicenter cohort study, between April 2022 and January 2024. The primary endpoint was all-cause mortality. Results: Among 1410 patients included in the analysis (28.4% females and 71.6% males), 41.1% had ischemic HF etiology, and 58.9% had non-ischemic HF etiology. Ischemic etiology was identified in 28.5% of females and 46.0% of males; p < 0.001. The adjusted hazard ratio (aHR) was 1.16 (95% CI 0.85–1.58; p = 0.363) for all-cause mortality in the non-ischemic group relative to the ischemic reference category. The aHR for all-cause mortality in women relative to men was 1.14 (95% CI: 0.67–1.94; p = 0.633) for ischemic HF and 0.85 (95% CI: 0.56–1.27; p = 0.420) for non-ischemic HF. Conclusions: We found that ischemic and non-ischemic etiologies are associated with comparable all-cause mortality risk in patients with HF. Sex-stratified analyses revealed no significant mortality differentials between women and men within either etiologic category.