Sex Differences in In-Hospital Mortality in Acute Decompensated Heart Failure With Reduced and Preserved Ejection Fraction

Study Questions:

Does sex impact outcome in hospitalized patients with acute heart failure (HF) and preserved or reduced ejection fraction (EF)?


This was an analysis of Get With The Guidelines-Heart Failure registry data. All patients had a primary discharge diagnosis of HF. They were classified as either having preserved (EF ≥50%) or reduced (EF <40%) EFs. The primary outcome was in-hospital mortality based on sex and HF classification.


There were 51,428 HF patients with a reduced EF, of which 36% were females. There were 37,699 patients with a preserved EF (35% female). Overall, regardless of HF classification, females tended to be older than men and were more likely to have a diagnosis of hypertension and depression. Women were less likely to have coronary disease or peripheral vascular disease. In-hospital mortality (range 2.6-2.9%) was similar for men and women regardless of HF classification (and p > 0.20 for all comparisons). For both men and women, age, renal failure, lower systolic blood pressure, and higher heart rate were multivariable predictors of inpatient mortality, but the magnitude of assigned risk for each predictor differed between sexes and HF classifications.


The authors concluded that mortality is similar for men and women with HF, regardless of HF classification. HF with preserved EF carries a similar mortality as that of patients with reduced EF.


Using a large registry of data on patients with HF, the authors show that: 1) mortality from HF is similar for men and women, and 2) mortality from HF is similar for HF subtypes. Unfortunately, mortality comparisons for sex and HF classification were not adjusted for differences in baseline characteristics. When examining risk factors for HF mortality, the magnitude of risk from age was lowest in women with reduced EF (odds ratio [OR], 1.27) and highest in women with preserved EF (OR, 1.44), but similar for men regardless of HF type (OR, 1.35). Likewise, the magnitude of mortality risk (OR, 2.1) from renal failure in women with low EF tended to be higher than that of women (OR, 1.72) and men (OR, 1.36) with preserved EF and renal failure. This suggests that the overall ‘disease’ of HF may really not be similar between the various groups.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Hypertension

Keywords: Heart Diseases, Hospital Mortality, Cardiology, Heart Failure, Coronary Disease, Stroke Volume, Ventricular Function, Risk Factors, Heart Rate, Hypertension, Peripheral Vascular Diseases

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