Key result
Women with heart failure were significantly more likely to report worsening symptoms at 12 months compared to men (OR 1.78; 95% CI 1.00-3.16).
Why the study?
The study aimed to examine sex-stratified differences in the association of LVEF-based heart failure subtypes with the characteristics and correlates of self-reported symptom changes.
Observational (n=528)
Yes
Odds Ratio: 1.78 (95% CI 1–3.16)
There is significant sex-based heterogeneity in heart failure symptom characteristics and trajectories, with women being more likely to experience worsening symptoms over 12 months.
Sex differences in HF symptom changes by subtype are hypothesis-generating; prospective studies needed before clinical adoption.
AIMS: To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms. METHODS AND RESULTS: We report a secondary data analysis from 528 hospitalized individuals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated; with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12-month follow-up, most KCCQ scores had not significantly changed. However, 25% of individuals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (P = 0.025). On an adjusted basis, women [odds ratios (OR): 1.78, 95% confidence interval (CI): 1.00-3.16 vs. men], those with coronary artery disease (OR: 2.01, 95% CI: 1.21-3.31) and baseline acute pulmonary oedema (OR: 1.67, 95% CI: 1.02-2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR: 2.16, 95% CI: 1.07-4.35) and a non-English-speaking background (OR: 2.30, 95% CI: 1.02-5.20). CONCLUSION: We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalized with the syndrome. TRIAL REGISTRATION: ANZCTR12613000921785.
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Seckin et al. (2022) conducted an observational in Heart failure (n=528). Female sex vs. Male sex was evaluated on Worsening symptoms at 12 months (OR 1.78, 95% CI 1.00-3.16). Women with heart failure were significantly more likely to report worsening symptoms at 12 months compared to men (OR 1.78; 95% CI 1.00-3.16).
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