Abstract 12044: Sex-Related Differences in Long-Term Outcomes Across the Spectrum of Left Ventricular Ejection Fraction in Acute Decompensated Heart Failure Patients
Akane Kawai, Yuji Nagatomo, Midori Iwashita, Yukinori Ikegami, Makoto Takei, Ayumi Goda, Takashi Kohno, Atsushi Mizuno, Mitsunobu Kitamura, Shintaro Nakano, Munehisa Sakamoto, Yasuyuki Shiraishi, Shun Kohsaka, Takeshi K Adachi, Tsutomu Yoshikawa,- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: An important knowledge gap remains on sex-related differences in heart failure (HF) management. Recently, it has been recognized that patients, particularly women, with supra-normal left ventricular ejection fraction (snLVEF) are at high risk of adverse outcomes.
Aims: We sought to evaluate the sex related differences of long-term outcomes across the spectrum of LVEF in acute decompensated HF (ADHF) patients.
Methods: We analyzed 3943 ADHF patients (age 77 years; 59.8% male) who were enrolled in WET-HF multicenter registry in Japan from 2006 to 2017. The association of long-term outcomes across the spectrum of LVEF were compared between men and women.
Results: In both HF with reduced EF (HFrEF; LVEF < 50%) and preserved EF (HFpEF), female patients were older and had lower body mass index, lower prevalence of ischemic etiology, and smaller LV chamber size. In HFrEF, implementation of guideline-directed medical therapy such as the combination of renin-angiotensin-system inhibitor (RASi), β-blocker and mineralocorticoid receptor antagonist (MRA) was significantly lower in women at discharge, even after adjustment for covariates (RASi + β-blocker : odds ratio [OR], 0.80, p=0.049; RASi + β-blocker + MRA: OR, 0.73, p=0.016). Female patients showed higher incidence of the primary endpoint, defined as the composite of cardiac death and ADHF readmission during 1,000 days after discharge ( p = 0.009, log-rank test). However, female sex did not remain significant after adjustment for covariates. Restricted cubic spline analysis demonstrated a U-shaped relationship with a nadir at LVEF 60% between LVEF and the hazard ratio of the primary endpoint in women, but this relationship was not observed in men ( p for interaction = 0.048, Figure A, B ). This trend was more evident after excluding patients with valvular heart disease ( p for interaction = 0.014, Figure C, D ).
Conclusions: In women, not only low LVEF but also snLVEF were associated with worse long-term outcomes.