Serviço de Prevencao, Cardiopatia na Mulher e Reabilitação Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil.
Hospital Dia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil.
Int J Environ Res Public Health. 2022 Dec 2;19(23):16171. doi: 10.3390/ijerph192316171.
Heart failure (HF) is one of the leading causes of death worldwide. Studies show that women have better survival rates than men despite higher hospitalizations. However, little is known about differences in mortality and predictors of death in women and men with HF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF).
From February 2017 to September 2020, mortality and predictors of death were analyzed in women and men with HF. Baseline data included clinical characteristics and echocardiographic findings.
A total of 11,282 patients, 63.9 ± 14.4 years, including 6256 (55.4%) males, were studied. Females were older, had a higher baseline mean left ventricular ejection fraction (LVEF) and lower left ventricular diastolic diameter. During follow-ups, 1375 (22%) men and 925 (18.4%) women died. Cumulative incidence of death was higher in men with HFrEF but similar for HFmrEF and HFpEF. Cox regression for death showed renal dysfunction, stroke, diabetes, atrial fibrillation, age, LVEF, valve disease, MI, and hypertensive CMP as independent death predictors for all HF patients.
Women had a better prognosis than men in HFrEF and similar mortality for HFmrEF and HFpEF, but sex was not an independent predictor of death for all HF subtypes.
心力衰竭（HF）是全球主要死亡原因之一。研究表明，尽管女性住院率较高，但女性的生存率却高于男性。然而，对于射血分数保留型心力衰竭（HFpEF）、射血分数轻度降低型心力衰竭（HFmrEF）和射血分数降低型心力衰竭（HFrEF）患者中，女性与男性在死亡率和死亡预测因素方面的差异知之甚少。
本研究从 2017 年 2 月至 2020 年 9 月分析了 HF 患者的死亡率和死亡预测因素。基线数据包括临床特征和超声心动图结果。
共纳入 11282 例患者，年龄为 63.9±14.4 岁，包括 6256 例（55.4%）男性。女性患者年龄更大，左心室射血分数（LVEF）基线均值更高，左心室舒张直径更小。随访期间，1375 例（22%）男性和 925 例（18.4%）女性死亡。HFrEF 患者的死亡累积发生率较高，但 HFmrEF 和 HFpEF 患者的死亡累积发生率相似。Cox 回归分析显示，肾功能不全、卒中等、糖尿病、心房颤动、年龄、LVEF、瓣膜病、心肌梗死和高血压性 CMP 是所有 HF 患者死亡的独立预测因素。
在 HFrEF 中，女性的预后优于男性，HFmrEF 和 HFpEF 的死亡率相似，但性别并不是所有 HF 亚型死亡的独立预测因素。
