Sex differences in 1‐year mortality risks in older patients experiencing a first acute heart failure hospitalization

Abstract

Aim To assess whether 1‐year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex. Methods We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3‐year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis. Results There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1‐year all‐cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio [HR] 0.35, 95% confidence interval [95% CI] 0.21–0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16–3.40), systolic blood pressure (HR 0.98, 95% CI 0.97–0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12–3.85), number of chronic therapies (HR 1.12, 95% CI 1.05–1.19) and 1‐year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97–0.98) and higher potassium values (HR 1.42, 95% CI 1.01–2.00). Conclusions Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184–188.

Mortality and Readmission Rates After Heart Failure: A Systematic Review and Meta-Analysis

“…The flow diagram of the study selection process is shown in Figure 1 . We identified 27 studies included in this meta-analysis that reported 30-day and 1-year readmission data and mortality after HF, 18–28 , 32–47 including 1 trial conducted in Japan, 18 12 in the US, 19 , 21 , 23–25 , 27 , 33 , 34 , 36 , 38 , 44 , 47 1 in Italy, 20 2 in Spain, 22 , 39 1 in India, 40 1 in Singapore, 41 1 in Romania, 42 1 in France, 26 1 in Australia, 28 1 in Switzerland, 32 1 in Korea, 35 1 in Argentina, 37 1 in South Africa, 43 1 in Europe 45 and 1 in England. 46 The total number of participants was 515,238.…”

“…43 Most of the articles reported similar data for 1-year all-cause mortality, ie, 29%. 32,34,36,[38][39][40]43,[45][46][47] The careful management of HF outpatients who are elderly, high disease severity, multiple comorbidities, or taking beta-blockers, loop diuretics, thiazide, or nitrates when discharged from the hospital may be critical to reducing the 30-day readmission. 18 In some studies assessed in this meta-analysis, the authors identified multiple predictive factors of readmission, including age 18,20,21 and clinical comorbidities.…”

“…The flow diagram of the study selection process is shown in Figure 1. We identified 27 studies included in this meta-analysis that reported 30-day and 1-year readmission data and mortality after HF, [18][19][20][21][22][23][24][25][26][27][28][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] including 1 trial conducted in Japan, 18 12 in the US, 19,21,[23][24][25]27,33,34,36,38,44,47 1 in Italy, 20 2 in Spain, 22,39 1 in India, 40 1 in Singapore, 41 1 in Romania, 42 1 in France, 26 1 in Australia, 28 1 in Switzerland, …”

Cognitive impairment in patients with heart failure: an international study

“…shortness of breath and fatigue) that impair quality of life 3 and is also associated with high mortality rates, recurrent hospitalizations, and high direct and indirect costs. [4][5][6] Cognitive impairment (CI) is a common co-morbid condition in patients with HF. 7 Several studies have shown that CI in HF ranges between 20% and 80%, 7,8 and that CI is associated with poor HF outcomes, such as death, hospital readmission, and poor self-care.…”

“…HF is associated with several symptoms (e.g. shortness of breath and fatigue) that impair quality of life and is also associated with high mortality rates, recurrent hospitalizations, and high direct and indirect costs …”