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Objectives

 

At the end of this section you will be able to:

  • Explain how the roles of certain heart failure predictors vary between genders

  • Explain the sex and gender based differences in prognosis between men and women

Prognosis and Gender (I)

Women tend to have a better prognosis than men [1]. Many studies attest to women’s better survival rates:

  • One study showed the five year survival rate for women to be 38% and for men, 25% [2]

  • Another showed women to have better survival rates over 10-15 years for all age groups [3]

  • This accounts for the fact that the prevalence of heart failure is equal between men and women, yet the incidence of the illness is higher in men [4]

 

Prognosis and Gender (II)

  • Atrial fibrillation is a predictor of prognosis in women, but not in men [11]

  • QRS duration and BMI are predictors of prognosis in men [11]

  • Coronary artery disease increases the risk of mortality 2.5 times in women, and only 1.5 times in men [11]

  • Left ventricle ejection fraction (LVEF) appears to be a stronger predictor of prognosis in women [11]

  • In patients whose heart failure etiology is non-ischemic, women have significantly better survival rates than men [12]

In summary, the majority of studies indicate the women with HF have a better prognosis than men. One study attempted to see if these studies were influenced by gender related differences in baseline characteristics; for example most female heart failure patients are older than men, and females often have a preserved LVEF. In this study, all participants had the same baseline characteristics. The experiment showed that even in this case, women had better outcomes in terms of fewer major cardiac events [13].

 

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1. Mejhert M, Holmgren J, Wandell P, Persson H, Edner M. Diagnostic tests, treatment and follow-up in heart failure patients - is there a gender bias in the coherence to guidelines? European Journal of Heart Failure. 1999;1:407-410.

2. Ho KK, Anderson KM, Kannel WB, GRoossman W, Levy D. Survival after the onset of congestive cardiac failure in Framingham Heart study subjects. Circulation 1993;88:107-15.

3. Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 1992;20;301-6.

4. Stromberg A, Martensson J. Gender differences in patients with heart failure. European Journal of Cardiovascular Nursing. 2003;2:7-18.

11. Ghali JK, Krause-Steinrauf HJ, Adams KF, Khan SS, Rosenberg YD, Yancy CW, Young JB, GOldman S, Peberdy MA, Lindenfeld J. Gender Differences in Advaned Heart Failure: Insights from the BEST Study. Journal of the American College of Cardiology. 2003;42(12):2128-34

12. Galvao M, Kalman J, DeMarco T, Fonarow GC, Galvin C, Ghali JK, Moskowitz RM, on behalf of the ADHERE scientific advisory committee, investigators coordinators, and study group. Gender Differences in In-Hospital Management and Outcomes in Patients with Decompensated Heart Failure: Analysis from the Acute Decompensated Heart Failure National Registry (AHERE). Journal of Cardiac Failure. 2006;12(2):100-7

13. Grigioni F, Barbieri A, Russo A, Reggianini L, Bonatti S, Potena L, Fabbri F, Coccolo F, Magnani G, Bursi F, Magelli C, Modena MG, Branzi A. Prognostic Stratification of Women With CHronic Heart Failure Referred for Heart Transplantation: Relevance of Gender as Compared with Gender-related Characteristics. Clinical Heart Transplantation. 2005;25(6):648-652

All references for this section