Gender Differences in Severity and Outcomes of Left Ventricular Heart Failure
Overview
This national cohort analysis of over 2.6 million LVHF hospitalizations in Germany reveals significant sex-related differences in disease severity, treatment, and in-hospital outcomes. Women with LVHF were less likely to receive guideline-recommended interventions and had distinct comorbidity profiles compared to men, impacting mortality and length of stay across NYHA classes.
Background
Left ventricular heart failure (LVHF) is a major cause of morbidity and mortality globally, classified by NYHA functional class and left ventricular ejection fraction (LVEF). Sex influences the epidemiology, pathophysiology, and management of LVHF, with women often underdiagnosed and undertreated. Understanding sex-specific disparities in LVHF severity and outcomes is critical for optimizing care. This study leverages comprehensive nationwide German hospital data from 2014 to 2022 to explore these differences across NYHA classes.
Data Highlights
The dataset included 2,616,462 inpatient cases with primary LVHF diagnosis from 2014 to 2022. Cases were stratified by NYHA class and sex. Baseline cardiovascular risk factors, comorbidities, interventions, complications, and in-hospital outcomes such as mortality and length of stay were analyzed. The data source covers virtually all hospitalizations in Germany, ensuring comprehensive population-level insights.
Key Findings
Women with LVHF were less frequently treated with guideline-recommended therapies and less likely to undergo heart transplantation compared to men.
Sex disparities in LVHF outcomes varied across NYHA classes, with women showing different patterns of disease progression and mortality risk.
Women had distinct comorbidity profiles, including differences in prevalence of hypertension, diabetes, and atrial fibrillation, influencing clinical outcomes.
Men were more likely to receive invasive interventions such as PCI, CABG, and assist device implantation.
In-hospital mortality and length of stay differed by sex and NYHA class, highlighting the need for sex-specific management strategies.
Clinical Implications
Clinicians should recognize sex-specific differences in LVHF presentation and progression to tailor diagnostic and therapeutic approaches. Ensuring equitable access to guideline-recommended treatments and advanced interventions for women may improve outcomes. Awareness of distinct comorbidity patterns can guide risk stratification and management decisions.
Conclusion
This large-scale analysis underscores significant gender-related variations in LVHF severity, treatment, and outcomes, emphasizing the importance of integrating sex-specific considerations into clinical practice to reduce disparities and optimize patient care.
References
2023 ESC Guidelines -- Diagnosis and treatment of heart failure
Despite major advances in guideline-directed medical therapy (GDMT), worsening heart failure continues to drive significant morbidity, repeat hospitalizations and healthcare utilization worldwide.
