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Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial.

AbstractBACKGROUND:
There are few sex-specific outcome data in heart failure with preserved ejection fraction.
METHODS AND RESULTS:
We assessed sex differences in baseline characteristics and outcomes among 4128 patients with heart failure with preserved ejection fraction in the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Women (n=2491) with heart failure with preserved ejection fraction were ≈1 year older (72±7 years versus 71±7 years) and more likely to be obese (46% versus 35%) and have chronic kidney disease (34% versus 26%) and hypertension (91% versus 85%) than men but less likely to have an ischemic cause (19% versus 34%), atrial fibrillation (27% versus 33%), or chronic obstructive pulmonary disease (8% versus 13%) (all P<0.001). During a mean of 49.5 months, there were 881 deaths (447 in women, 434 in men; risk ratio, 0.64; 95% CI, 0.56-0.74) and 5776 hospitalizations (3239 in women, 2537 in men; risk ratio, 0.80; 95% CI, 0.76-0.84). Women had lower risk of all-cause events (deaths and hospitalizations), even after adjusting for baseline characteristics (adjusted hazards ratio, 0.81; 95% CI, 0.73-0.89). However, the sex-related difference in risk of all-cause events was modified in the presence or absence of atrial fibrillation, renal dysfunction, stable angina pectoris, or advanced New York Heart Association class symptoms.
CONCLUSIONS:
In patients with typical heart failure with preserved ejection fraction, there were prominent sex differences in baseline characteristics and outcomes. Women had better overall prognosis, although the presence of 4 common baseline characteristics seemed to moderate this finding.
AuthorsCarolyn S P Lam, Peter E Carson, Inder S Anand, Thomas S Rector, Michael Kuskowski, Michel Komajda, Robert S McKelvie, John J McMurray, Michael R Zile, Barry M Massie, Dalane W Kitzman
JournalCirculation. Heart failure (Circ Heart Fail) Vol. 5 Issue 5 Pg. 571-8 (Sep 1 2012) ISSN: 1941-3297 [Electronic] United States
PMID22887722 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)
Chemical References
  • Angiotensin II Type 1 Receptor Blockers
  • Biphenyl Compounds
  • Tetrazoles
  • irbesartan
Topics
  • Age Factors
  • Aged
  • Angiotensin II Type 1 Receptor Blockers (therapeutic use)
  • Biphenyl Compounds (therapeutic use)
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Health Status Disparities
  • Heart Failure (diagnosis, drug therapy, mortality, physiopathology)
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Stroke Volume
  • Tetrazoles (therapeutic use)
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left

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