Influence of sex and pregnancy on survival in patients admitted with heart failure: Data from a prospective multicenter registry

Martínez‐Sellés, Manuel; Díez‐Villanueva, Pablo; García, Jesús A. Valdez; Ferrero‐Gregori, Andreu; Vives‐Borrás, Miquel; Worner, Fernando; Bardajı́, Alfredo; Delgado, Juan; Vázquez, Rafael; González-Juanatey, José Ramón; Fernández‐Avilés, Francisco; Cinca, Juan

doi:10.1002/clc.22979

Cited by 21 publications

(14 citation statements)

References 35 publications

(62 reference statements)

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“…Interestingly, age was associated with a higher probability of LVEF improvement, with no sex differences [7][8][9][10]. In other studies, female sex was associated with fewer events during follow-up [21], being a predictor of LVEF recovery [7,9,10]. In our study, there was a higher proportion of women in group R, though the differences did not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 65%

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

et al. 2020

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Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (> 35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF > 35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), Díez-Villanueva et al. with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

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Section: Discussioncontrasting

confidence: 65%

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

et al. 2020

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“…Women with heart failure have a poorer functional class than men [33] but have a better prognosis [17, 34]. The greater functional class improvement we found in women could be related with this fact and with other sex-related aspects [35]. Women had a similar SV discontinuation rate than men.…”

Section: Discussionmentioning

confidence: 64%

Sex Influence on the Efficacy and Safety of Sacubitril/Valsartan

et al. 2019

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Background: Women are underrepresented in sacubitril/valsartan (SV) clinical trials. The aim of this study was to assess sex-specific differences in efficacy, tolerability, and safety of SV in real-world heart failure with reduced ejection fraction (HFrEF) patients. Methods: A prospective registry in 10 centers including all patients who started SV during the last 6 months was analyzed in this study. Results: A total of 427 patients were included, 126 (29.5%) were women. There were no substantial differences in HFrEF treatment before SV initiation, although fewer women than men carried an implantable cardioverter defibrillator (57 [45.2%] vs. 173 [58.1%], p = 0.02). SV starting dose was 24/26 mg b.i.d. in 206 patients (48.2%), 49/51 mg b.i.d. in 184 (43.1%), and 97/103 mg b.i.d. in 34 (8.2%), without relevant differences associated to sex. There were no losses during a mean follow-up of 7.0 ± 0.1 months. The proportion of patients who discontinued the drug (16 [12.7%] women vs. 33 [11.0%] men, p = 0.66) or presented SV-related adverse effects (31 [24.6%] women vs. 79 [26.5%] men, p = 0.72) was also similar in both sexes. However, female sex was an independent predictor of functional class improvement in the multivariate analysis (odds ratio 2.33, 95% confidence interval: 1.24–4.38, p = 0.04). Conclusions: SV in women with HFrEF has a similar tolerability as in men. Females seem to have a more frequent functional class improvement than males.

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“…This microchimerism has been hypothesized to be beneficial for the mother's heart, and even lead to a better tolerance to the graft in case of transplant ( 117 ). Although more studies are required to quantify the benefits of previous pregnancies in HF outcomes, a previous series including 756 females with HF found an association between the number of previous gestations and better 1-year survival (HR 0.878, 95% CI: 0.773–0.997, P = 0.045) ( 118 )…”

Section: Biological Differencesmentioning

confidence: 99%

Sex Influence on Heart Failure Prognosis

Postigo

Martínez‐Sellés

2020

Front. Cardiovasc. Med.

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Heart failure (HF) affects 1–2% of the population in developed countries and ~50% of patients living with it are women. Compared to men, women are more likely to be older and suffer hypertension, valvular heart disease, and non-ischemic cardiomyopathy. Since the number of women included in prospective HF studies has been low, much information regarding HF in women has been inferred from clinical trials observations in men and data obtained from registries. Several relevant sex-related differences in HF patients have been described, including biological mechanisms, age, etiology, precipitating factors, comorbidities, left ventricular ejection fraction, treatment effects, and prognosis. Women have greater clinical severity of HF, with more symptoms and worse functional class. However, females with HF have better prognosis compared to males. This survival advantage is particularly impressive given that women are less likely to receive guideline-proven therapies for HF than men. The reasons for this better prognosis are unknown but prior pregnancies may play a role. In this review article we aim to describe sex-related differences in HF and how these differences might explain why women with HF can expect to survive longer than men.

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Influence of sex and pregnancy on survival in patients admitted with heart failure: Data from a prospective multicenter registry

Abstract: In patients admitted with HF, female sex and the number of previous pregnancies are independently associated with better 1-year survival.

Cited by 21 publications

References 35 publications

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Sex Influence on the Efficacy and Safety of Sacubitril/Valsartan

Sex Influence on Heart Failure Prognosis

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