The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Sex differences in clinical characteristics and long-term outcome in patients with heart failure: data from the KorAHF registry

  • Hyue Mee Kim (Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Hack-Lyoung Kim (Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine) ;
  • Myung-A Kim (Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine) ;
  • Hae-Young Lee (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Jin Joo Park (Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Dong-Ju Choi (Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2023.07.07
  • Accepted : 2023.09.08
  • Published : 2024.01.01
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Abstract

Background/Aims: Sex differences in the prognosis of heart failure (HF) have yielded inconsistent results, and data from Asian populations are even rare. This study aimed to investigate sex differences in clinical characteristics and long-term prognosis among Korean patients with HF. Methods: A total of 5,625 Korean patients hospitalized for acute HF were analyzed using a prospective multi-center registry database. Baseline clinical characteristics and long-term outcomes including HF readmission and death were compared between sexes. Results: Women were older than men and had worse symptoms with higher N-terminal pro B-type natriuretic peptide levels. Women had a significantly higher proportion of HF with preserved ejection fraction (HFpEF). There were no significant differences in in-hospital mortality and rate of guideline-directed medical therapies in men and women. During median follow-up of 3.4 years, cardiovascular death (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.07-1.78; p = 0.014), and composite outcomes of death and HF readmission (adjusted HR, 1.13; 95% CI, 1.01-1.27; p = 0.030) were significantly higher in men than women. When evaluating heart failure with reduced ejection fraction (HFrEF) and HFpEF separately, men were an independent risk factor of cardiovascular death in patients with HFrEF. Clinical outcome was not different between sexes in HFpEF. Conclusions: In the Korean multi-center registry, despite having better clinical characteristics, men exhibited a higher risk of all-cause mortality and readmission for HF. The main cause of these disparities was the higher cardiovascular mortality rate observed in men compared to women with HFrEF.

Keywords

Acknowledgement

These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. KorAHF Investigators: Byung-Hee Oh, Myeong-Chan Cho, Jae-Joong Kim, Sang Hong Baek, Eun-Seok Jeon, Dong-Ju Choi, Youngkeun Ahn, Byung-Su Yoo, Seok-Min Kang, Shung Chull Chae, Hae-Young Lee, Hyun-Jai Cho, Kye Hun Kim, Jin-Oh Choi, Kyung-Kuk Hwang, Min-Seok Kim, Suk Min Seo, Jin Joo Park, Sang Eun Lee, Jae Yeong Cho, Se Yong Jang, Ju Hee Lee, Jaewon Oh.

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