Baudry Guillaume, Pereira Ouarda, Roubille François, Villaceque Marc, Damy Thibaud, Duarte Kevin, Tangre Philippe, Girerd Nicolas
Université de Lorraine, INSERM, Centre d'Investigation Clinique Plurithématique 1433, Inserm U1116, CHRU de Nancy, Nancy, France.
INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France.
Eur J Heart Fail. 2025 Jun 20. doi: 10.1002/ejhf.3733.
Heart failure (HF) prognosis is influenced by demographic, clinical, and healthcare-related factors, with sex playing a crucial role. However, sex-based differences in HF management and outcomes remain insufficiently characterized in real-world settings. This study aimed to assess sex-related disparities in HF prognosis and management using a comprehensive nationwide cohort.
This study utilized the French-DataHF cohort, including all French patients diagnosed with HF in the previous 5 years and alive on 1 January 2020. Inverse probability weighting (IPW) was applied to adjust for baseline differences in assessing prognosis and management. The primary outcome was all-cause mortality (ACM), while secondary outcomes included HF hospitalization and their composite. Survival analyses were performed using Cox proportional hazards models, adjusted for demographic, clinical, and healthcare factors. The study included 655 919 patients (48% female). One-year ACM was 16.8% in females vs. 15.1% in males. In IPW-adjusted analyses, females received less renin-angiotensin system inhibitors (52.8% vs. 61.5%), while a higher proportion had no annual cardiology follow-up (33.8% vs. 27.9%). In the fully adjusted model, females had a 21% lower ACM risk (adjusted hazard ratio [aHR] 0.79, 95% confidence interval [CI] 0.79-0.80) and a 15% lower composite outcome risk (aHR 0.85, 95% CI 0.85-0.86). Cardiology follow-up was associated with lower ACM risk across sexes, with adjusted risk differences ranging from 21% for one consultation to 41% for ≥4 consultations.
While females had a better-adjusted prognosis, disparities in guideline-directed medical therapy utilization and cardiology follow-up nonetheless persist. Enhancing access to specialized care for women with HF could further optimize outcomes and reduce mortality.
心力衰竭（HF）的预后受人口统计学、临床及医疗保健相关因素影响，性别在其中起着关键作用。然而，在实际临床环境中，HF管理和预后的性别差异仍未得到充分描述。本研究旨在通过一项全国性综合队列评估HF预后和管理中的性别差异。
本研究使用了法国DataHF队列，纳入了过去5年内在法国被诊断为HF且在2020年1月1日仍存活的所有患者。采用逆概率加权法（IPW）对评估预后和管理时的基线差异进行调整。主要结局为全因死亡率（ACM），次要结局包括HF住院及其复合结局。使用Cox比例风险模型进行生存分析，并对人口统计学、临床和医疗因素进行了调整。该研究纳入了655919例患者（48%为女性）。女性的1年ACM为16.8%，男性为15.1%。在IPW调整分析中，女性接受肾素-血管紧张素系统抑制剂的比例较低（52.8%对61.5%），而未进行年度心脏科随访的比例较高（33.8%对27.9%）。在完全调整模型中，女性的ACM风险降低21%（调整后风险比[aHR]0.79，95%置信区间[CI]0.79 - 0.80），复合结局风险降低15%（aHR 0.85，95%CI 0.85 - 0.86）。心脏科随访与两性较低的ACM风险相关，调整后的风险差异范围从一次会诊的21%到≥4次会诊的41%。
虽然女性调整后的预后较好，但在指南指导的药物治疗使用和心脏科随访方面的差异仍然存在。加强对HF女性患者的专科护理可进一步优化结局并降低死亡率。
