June 20, 2026Journal of the American College of Cardiology
Associations of Gender and Etiology With Outcomes in Heart Failure With Systolic Dysfunction
Key result
Female sex is associated with ~23% lower mortality in HFrEF, alongside nonischemic etiology.
- HR 0.77
- 95% CI 0.69 to 0.85
- n=11,642
Why the study?
Limited data exist on gender-related differences in etiology and outcomes among patients with heart failure with systolic dysfunction.
Do gender and etiology affect survival and hospitalization outcomes in patients with heart failure with systolic dysfunction?
Population
8,791 men and 2,851 women with chronic HF from 5 randomized trials
Comparison
Outcomes compared by gender and etiology (ischemic vs nonischemic)
Design
Pooled analysis of 5 randomized clinical trials
Authors
Discussion
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Implication
Supports sex-specific HF prognosis and management; extends pooled RCT data to guide future trial stratification.
Key Points
- This study aims to investigate gender-related differences in etiology and outcomes among chronic heart failure patients with systolic dysfunction.
- Analyzed data from 8,791 men and 2,851 women randomized in 5 clinical trials.
- Explored disease etiology (ischemic vs. nonischemic) and outcomes (mortality and hospitalization).
- Generated hazard ratios, confidence intervals, and Kaplan-Meier survival curves by gender and etiology.
- Women comprised 18% of ischemic and 31% of nonischemic patients.
- Adjusted analysis showed female gender was associated with longer survival time (HR 0.77 [95% CI 0.69 to 0.85]).
- Time to death or hospitalization was longer among nonischemics (HR 0.83 [95% CI 0.78 to 0.89], p < 0.0001).
Study Design
Type
Observational (n=11,642)
Multicenter
Yes
Structured PICO
Do gender and etiology affect survival and hospitalization outcomes in patients with heart failure with systolic dysfunction?
P
Population
11,642 patients with heart failure with systolic dysfunction from 5 clinical trials, analyzed to determine the association of gender and etiology with mortality and hospitalization.
E
Exposure
Female gender and nonischemic etiology
C
Comparator
Male gender and ischemic etiology
O
Outcome
All-cause mortality and composite of death or all-cause hospitalizationcomposite
Main Result
Hazard Ratio: 0.77 (95% CI 0.69–0.85)
Female gender and nonischemic etiology are independently associated with better survival in patients with heart failure with systolic dysfunction.
Cite This Study
Frazier et al. (2007) conducted an observational in Heart failure with systolic dysfunction (n=11,642). Female gender vs. Male gender was evaluated on All-cause mortality (survival time) (HR 0.77, 95% CI 0.69 to 0.85). Female gender (HR 0.77; 95% CI 0.69-0.85) and nonischemic etiology (HR 0.80; 95% CI 0.72-0.89) were associated with longer survival time in patients with heart failure with systolic dysfunction.