Sex-specific differences in heart failure outcomes in Turkiye – a 2024 urban-rural analysis

Heart failure (HF) outcomes may vary by gender and geographic region, yet data from middle-income countries remain limited. This study aimed to evaluate the impact of gender and urban-rural residence on clinical outcomes and quality of life in HF patients from Tokat, Turkey. In this retrospective study, 200 HF patients (54% male, 50% rural) were analyzed. Baseline characteristics, including comorbidities and laboratory parameters, were compared by gender and region. Primary outcomes were mortality and hospital readmission at one year. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Cox regression analysis identified risk factors for adverse outcomes. Females exhibited higher mortality (17.4% vs. 13.0%, p=0.04) and hospital readmission rates (40.2% vs. 28.7%, p=0.02) than males, alongside worse MLHFQ scores (53.4 ± 15.4 vs. 46.0 ± 13.2, p<0.01). Rural patients had elevated mortality (20.0% vs. 10.0%, p=0.02) and ACCEPTED MANUSCRIPT Accepted manuscript readmission (43.0% vs. 25.0%, p<0.01) compared to urban counterparts, with poorer MLHFQ scores (54.8 ± 15.0 vs. 44.2 ± 13.0, p<0.001). Cox analysis identified low education (HR=1.85, 95% CI: 1.05-3.26, p=0.03) and healthcare access distance >20 km (HR=1.90, 95% CI: 1.15-3.14, p=0.02) as mortality predictors. SGLT-2 inhibitor use was associated with reduced readmission risk (HR=0.40, 95% CI: 0.18-0.89, p=0.02). Gender and regional disparities significantly influence HF outcomes in Tokat, with females and rural patients facing worse prognosis. Interventions targeting education, healthcare access, and optimized therapies may mitigate these inequities.