Sex differences in heart failure outcomes: nationwide data from 2015 to 2023
K Kobale, D Kosuta, K Pelicon, B Jug, T Furlan, J Farkas Lainscak, M Lainscak, Z Fras, P Dosenovic BoncaAbstract
Introduction
Heart failure (HF) remains a major cause of morbidity and mortality worldwide. Although sex-related differences in clinical presentation, management, and outcomes are increasingly recognised, comprehensive nationwide data remain limited.
Purpose
To assess sex-related differences in outcomes among patients with HF in a nationwide cohort between 2015 and 2023.
Methods
We conducted a nationwide, retrospective, longitudinal, observational study including patients hospitalised with a primary diagnosis of HF between 2015 and 2023. HF was diagnosed by the treating hospital physician and identified using International Classification of Diseases, 10th Revision (ICD-10) codes I50–I50.9. Data were obtained from administrative databases of a national health insurance system. The primary outcome was all-cause mortality; secondary outcomes included HF-related hospitalisations. Cox proportional hazards regression models were used to assess the risk of death and hospitalisation, adjusted for age and comorbidities.
Results
A total of 28,625 patients hospitalised for HF were included, with a near-equal sex distribution (53% women [n=15,103] and 47% men [n=13,522]). Women were older than men (82.2±9.3 vs 75.7±11.4 years, p<0.001); nearly two-thirds of women and just over one-third of men were aged ≥80 years. Women had a higher prevalence of arterial hypertension and mitral regurgitation, whereas men more frequently presented with diabetes mellitus, dyslipidaemia, coronary artery disease, peripheral artery disease, chronic kidney disease, and cancer (all p<0.001). In-hospital, 30-day, and 12-month mortality were higher in women than in men (16% vs 12%, 18% vs 14%, and 41% vs 36%, respectively). HF-related hospitalisations at 30 days were more frequent in men than in women (3.6% vs 2.7%), whereas at 12 months, women experienced higher rehospitalisation rates (49% vs 45%; p<0.001). In the Cox regression models accounting for age and comorbidities, women had higher risk of death (HR 1.18, 95% CI: 1.15–1.22) and HF-related hospitalisations (HR 1.11, 95% CI: 1.06–1.15) (Figures 1 and 2).
Conclusions
Sex-related differences in HF outcomes persist at the population level, highlighting the need for sex-specific risk stratification and tailored management strategies.Figure 1.For image description, please refer to the figure legend and surrounding text.Figure 2.For image description, please refer to the figure legend and surrounding text.