title: Patients' sex and emotional support as predictors of death and clinical deterioration in the waiting for a new heart study: results from the 1-year follow-up.
abstract: BACKGROUND
  Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates.
  
  
  OBJECTIVE
  To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study.
  
  
  METHODS
  The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs. low support]) were assessed at the time of wait-listing. Main Outcomes-Time until death/delisting due to deteriorated tealth, considering competing outcomes (e.g., transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models.
  
  
  RESULTS
  By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs. 8.6%) and being a past or current smoker (80.4% vs. 56.9%). More women than men had low vocational level (93.1% vs. 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04-5.12; P = .04); low emotional support further tended to increase the risk for this outcome (P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04-4.82; P = .04).
  
  
  CONCLUSIONS
  Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
authors: Department of Biology, Romberg Tiburon Center, San Francisco State University, 3150 Paradise Drive, Tiburon, CA 94920, USA. gweidner@sfsu.edu
authors: Gerdi
authors: G
authors: Weidner
authors: Daniela
authors: D
authors: Zahn
authors: Nancy R
authors: NR
authors: Mendell
authors: Jacqueline M A
authors: JM
authors: Smits
authors: Mario C
authors: MC
authors: Deng
authors: Armin
authors: A
authors: Zittermann
authors: Heike
authors: H
authors: Spaderna
mesh_terms: D001317:Austria / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D016027:Heart Transplantation / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D012944:Social Support; D015996:Survival Rate; D014850:Waiting Lists