Sex-based differences in 10-year mortality and risk factors following an initial acute heart failure episode

OBJECTIVE: To investigate sex-related differences in patient characteristics during the first episode of acute heart failure (AHF), and to assess long-term mortality and associated risk factors. METHODS: This is a secondary analysis of two prospective, multicenter Spanish registries, including patients with a first diagnosis of acute heart failure (AHF) across five Spanish hospitals. Patients with a first diagnosis of AHF in five Spanish hospitals were included and stratified by sex. Mortality was analyzed with Kaplan-Meier curves during up to 10 years of follow-up. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were estimated for sex and 16 clinical variables using multivariate Cox regression. First-degree interactions between sex and covariates were also tested. RESULTS: A total of 1986 patients were studied (992 women, 994 men). Men were younger but had more comorbidities, lower left ventricular ejection fraction, and more frequent prescription of mineralocorticoid receptor antagonists at discharge. Women presented with more advanced NYHA functional class. Mean survival was 5.1 years. Overall mortality was 20% at 1 year, 52% at 5 years, and 76% at 10 years after a first episode of AHF, without statistically significant sex differences. Subgroup analyses by ejection fraction also showed no sex-related survival differences. After adjustment, sex was not associated with mortality (aHR for men=1.109, 95% CI 0.991-1.242). Higher mortality was independently associated with age≥80, NYHA class III-IV, chronic kidney disease, diabetes, coronary artery disease, hypertension, and left bundle branch block. In contrast, treatment with renin-angiotensin system inhibitors and beta-blockers at discharge was associated with lower mortality. No significant sex interactions were identified regarding risk factors. CONCLUSION: Men and women with AHF differ in baseline clinical characteristics, but no statistically significant sex-based differences were observed in long-term survival or prognostic risk factors.