Sex-based differences in characteristics, management, and outcomes in heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction (HFrEF) exhibits significant sex-based differences in clinical presentation, management, and outcomes. This study aimed to evaluate these differences using data from the Swedish Heart Failure Registry (SwedeHF). We analyzed 65,605 patients with HFrEF (EF <40%) from the SwedeHF registry. Baseline characteristics, treatment patterns, and outcomes were compared between females and males. Multivariable logistic regression was used to evaluate predictors of treatment use. Cox proportional hazards models were used to assess the risk of cardiovascular mortality and heart failure (HF) hospitalization, adjusting for demographic and clinical variables. Odds ratios (OR) were reported for treatment use, and hazard ratios (HR) were used for outcome analyses. Females (29.0%) were older than males and had a higher prevalence of hypertension (61.3% vs 49.8%) and valvular disease (17.2% vs 11.1%), while males had a higher prevalence of ischemic heart disease (70.5% vs 40.1%) and diabetes (31.6% vs 28.4%). Males were less likely to receive beta-blockers (OR: 0.76, 95% CI 0.71-0.81), and more likely to receive sodium-glucose co-transporter-2 inhibitors (OR: 1.27, 95% CI 1.17-1.38) and implantable cardioverter-defibrillators/cardiac resynchronization therapy (OR: 1.41, 95% CI 1.30-1.52). During a median follow-up of 2.1 years, males had a higher risk of the composite outcome of cardiovascular death or HF hospitalization (HR: 1.19, 95% CI 1.16-1.22), cardiovascular death (HR: 1.33, 95% CI 1.28-1.37), and HF hospitalization (HR: 1.16, 95% CI 1.12-1.19). In this large cohort of patients with HFrEF, males had worse outcomes across all major cardiovascular endpoints. These findings highlight the need for tailored strategies to address sex-based disparities in HF management and improve outcomes for both sexes.