Abstract
Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time.
Methods and results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85).
Conclusions: Women are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.
| Original language | English |
|---|---|
| Pages (from-to) | 3-12 |
| Number of pages | 10 |
| Journal | European Journal of Heart Failure |
| Volume | 23 |
| Issue number | 1 |
| Early online date | 6 Sept 2020 |
| DOIs | |
| Publication status | Published - Jan 2021 |
Bibliographical note
Funding:The study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication. C.T. is a NIHR Academic Clinical Lecturer. A.R., S.L.F. and J.M.O.M. are supported by the NIHR Biomedical Research Centre Oxford (BRC) Oxford University Hospitals NHS Foundation Trust. J.M.O.M. is also supported by the NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative (MIC). N.J. is a Wellcome Trust Doctoral Research Fellow (grant number 203921/Z/16/Z). T.M. is funded by the CLAHRC West Midlands. F.D.R.H. acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC and Harris Manchester College, Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care.
Publisher Copyright:
© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Keywords
- Gender
- Heart failure
- Mortality
- Prognosis
- Sex
- Survival
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine