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

Carolyn 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

Research output: Contribution to journalArticlepeer-review

100 Scopus citations

Abstract

Background: 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 modifed in the presence or absence of atrial fibrillation, renal dysfiunction, 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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT000095238.

Original languageEnglish (US)
Pages (from-to)571-578
Number of pages8
JournalCirculation: Heart Failure
Volume5
Issue number5
DOIs
StatePublished - Sep 2012

Bibliographical note

Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.

Keywords

  • Aging
  • Heart failure
  • Preserved left ventricular function
  • Prognosis
  • Sex

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