title: Associations of gender and etiology with outcomes in heart failure with systolic dysfunction: a pooled analysis of 5 randomized control trials.
abstract: OBJECTIVE
  This study sought to explore the gender-related differences in etiology and outcomes in chronic heart failure (HF) patients from 5 randomized trials.
  
  
  BACKGROUND
  Each year, 550,000 new cases of HF are identified; however, there remain limited data on gender-related differences in etiology and outcomes among patients with HF with systolic dysfunction.
  
  
  METHODS
  We analyzed data from 8,791 men and 2,851 women randomized in 5 clinical trials (PRAISE [Prospective Randomized Amlodipine Survival Evaluation], PRAISE-2, MERIT-HF [Metoprolol Extended Release Randomized Intervention Trial in Heart Failure], VEST [Vesnarinone Trial], and PROMISE [Prospective Randomized Milrinone Survival Evaluation]) to explore gender-related differences in etiology (ischemic vs. nonischemic) and outcomes (all-cause mortality and death or all-cause hospitalization). Hazard ratios (HR), 95% confidence intervals (CIs), and Kaplan-Meier survival curves were generated by gender and etiology.
  
  
  RESULTS
  A total of 18% of ischemic and 31% of nonischemic patients were women. Irrespective of etiology, women were older, more ethnically diverse, and had higher systolic blood pressures, more diabetes, and severe HF symptoms, but less often smoked or had prior myocardial infarctions than men. Mean ejection fractions were similar between women (23.6%) and men (23.2%). The 1-year Kaplan-Meier survival estimates varied by gender and etiology (female nonischemics, HR 0.88 [95% CI 0.85 to 0.89]; female ischemics, HR 0.83 [95% CI 0.81 to 0.85]; male nonischemics, HR 0.84 [95% CI 0.83 to 0.85]; male ischemics, HR 0.79 [95% CI 0.78 to 0.81]). After adjustment, female gender (HR 0.77 [95% CI 0.69 to 0.85]) and nonischemic etiology (HR 0.80 [95% CI 0.72 to 0.89]) were associated with longer survival time. Time to death or hospitalization was longer among nonischemics (HR 0.83 [95% CI 0.78 to 0.89], p < 0.0001); however, female gender was not significantly associated with the composite outcome (HR 1.01 [95% CI 0.95 to 1.08]).
  
  
  CONCLUSIONS
  Our data clarify that outcomes differ by both gender and etiology among patients with HF with systolic dysfunction. Understanding these differences may lead to better management of HF patients and improved overall prognosis.
authors.affiliation: Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Camille G
authors.initials: CG
authors.lastname: Frazier
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Susan
authors.initials: S
authors.lastname: Anderson
authors.forename: Erik
authors.initials: E
authors.lastname: Iverson
authors.forename: Milton
authors.initials: M
authors.lastname: Packer
authors.forename: Jay
authors.initials: J
authors.lastname: Cohn
authors.forename: Sidney
authors.initials: S
authors.lastname: Goldstein
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D015996:Survival Rate; D013599:Systole; D016896:Treatment Outcome