Department of Internal Medicine Mayo Clinic Rochester MN USA.
Department of Quantitative Health Sciences Mayo Clinic Rochester MN USA.
J Am Heart Assoc. 2024 Jul 2;13(13):e033374. doi: 10.1161/JAHA.123.033374. Epub 2024 Jun 21.
The epidemiology and pathophysiology of heart failure (HF) differ in women and men. Whether these differences extend to the subgroup of patients with advanced HF is not well defined.
This is a retrospective cohort study of all adult Olmsted County, Minnesota residents with advanced HF (European Society of Cardiology criteria) from 2007 to 2017. Differences in survival and hospitalization risks in women and men following advanced HF development were examined using Cox proportional hazard regression and Andersen-Gill models, respectively. Of 936 individuals with advanced HF, 417 (44.6%) were women and 519 (55.4%) were men (self-reported sex). Time from development of HF to advanced HF was similar in women and men (median 3.2 versus 3.6 years). Women were older at diagnosis (mean age 79 versus 75 years), less often had coronary disease and hyperlipidemia, but more often had hypertension and depression (<0.05 for each). Advanced HF with preserved ejection fraction was more prevalent in women than men (60% versus 30%, p<0.001). There were no differences in adjusted risks of all-cause mortality (hazard ratio [HR], 0.89 [95% CI, 0.77-1.03]), cardiovascular mortality (HR, 0.85 [95% CI, 0.70-1.02]), all-cause hospitalizations (HR, 1.04 [95% CI, 0.90-1.20]), or HF hospitalizations (HR, 0.91 [95% CI, 0.75-1.11]) between women and men. However, adjusted cardiovascular mortality was lower in women versus men with advanced HF with reduced ejection fraction (HR, 0.72 [95% CI, 0.56-0.93]).
Women more often present with advanced HF with preserved ejection fraction and men with atherosclerotic disease and advanced HF with reduced ejection fraction. Despite these differences, survival and hospitalization risks are largely comparable in women and men with advanced HF.
心力衰竭（HF）的流行病学和病理生理学在女性和男性中存在差异。这些差异是否扩展到晚期 HF 患者亚组尚不清楚。
这是一项回顾性队列研究，纳入了 2007 年至 2017 年明尼苏达州奥姆斯特德县所有患有晚期 HF（欧洲心脏病学会标准）的成年居民。使用 Cox 比例风险回归和 Andersen-Gill 模型分别检查了女性和男性在晚期 HF 发展后的生存和住院风险差异。在 936 名患有晚期 HF 的患者中，417 名（44.6%）为女性，519 名（55.4%）为男性（自述性别）。从 HF 发展到晚期 HF 的时间在女性和男性中相似（中位数分别为 3.2 年和 3.6 年）。女性在诊断时年龄较大（平均年龄为 79 岁，而男性为 75 岁），较少患有冠心病和高脂血症，但更常见的是患有高血压和抑郁症（<0.05）。女性晚期 HF 射血分数保留的比例高于男性（60%比 30%，p<0.001）。在全因死亡率（风险比[HR]，0.89[95%可信区间，0.77-1.03]）、心血管死亡率（HR，0.85[95%可信区间，0.70-1.02]）、全因住院率（HR，1.04[95%可信区间，0.90-1.20]）和 HF 住院率（HR，0.91[95%可信区间，0.75-1.11]）方面，女性和男性之间没有差异。然而，在射血分数降低的晚期 HF 患者中，女性的心血管死亡率低于男性（HR，0.72[95%可信区间，0.56-0.93]）。
女性更常出现射血分数保留的晚期 HF，而男性则更常出现动脉粥样硬化疾病和射血分数降低的晚期 HF。尽管存在这些差异，但女性和男性晚期 HF 的生存和住院风险基本相当。
