RELATION BETWEEN GENDER, ETIOLOGY AND SURVIVAL IN PATIENTS WITH SYMPTOMATIC HEART-FAILURE

Objectives. This study investigated the relation between gender, etiol ogy and survival in patients with symptomatic heart failure. Backgroun d. Previous work provides conflicting results concerning the relation between gender, clinical characteristics and survival in patients with heart failure. Methods. We examined the relation of these factors in 557 patients (380 men, 177 women) who had symptomatic heart failure, p redominantly nonischemic in origin (68%) and typically associated with severe left ventricular dysfunction. Results. Follow-up data were ava ilable in 99% of patients (mean follow-up period 2.4 years, range 1 da y to 10 years) after study entry, and 201 patients reached the primary study end point of all-cause mortality. By life-table analysis, women were significantly less likely to reach this primary end point than m en (p < 0.001). A significant association was found between female gen der and better survival (p < 0.001), which depended on the primary eti ology of heart failure (p = 0.008 for the gender-etiology interaction) but not on baseline ventricular function. Women survived longer than men when heart failure was due to nonischemic causes (men vs. women: r elative risk [RR] 2.36, 95% confidence interval [CI] 1.59 to 3.51, p < 0.001). In contrast, outcome appeared similar when heart failure was due to ischemic heart disease (men vs. women: RR 0.85, 95% CI 0.45 to 1.61, p = 0.651). Conclusions. Women with heart failure due to nonisch emic causes had significantly better survival than men with or without coronary disease as their primary cause of heart failure. (C) 1996 by the American College of Cardiology