title: Sex-specific acute heart failure phenotypes and outcomes from PROTECT.
abstract: OBJECTIVE
  Differences in manifestation, treatment, and outcomes of acute heart failure between men and women have not been well studied. The objective of this analysis was to characterize differences in clinical presentation, and in-hospital and post-discharge outcomes between sexes in acute heart failure patients.
  
  
  RESULTS
  Clinical profiles, treatment characteristics, and outcomes were compared between sexes in 2033 patients hospitalized for acute heart failure and impaired renal function. Women comprised 33% of the study population and were older, had higher body mass index, LVEF, and systolic blood pressure, and a greater prevalence of diabetes. At baseline, women showed signs and symptoms of congestion comparable with men, but more often had rales, orthopnoea, and worse renal function. Women were less intensively diuresed, as indicated by lower oral and intravenous diuretic doses used, fewer dose increases, and less total weight loss during hospitalization. Furthermore, hospitalization was slightly but significantly prolonged in women (11.04 ± 7.8 vs. 10.65 ± 8.86 days; P = 0.024). Age-adjusted 180-day mortality was lower in women (15.8% vs. 18.5%, hazard ratio 0.74; 95% confidence interval 0.59-0.93, P = 0.010), but multivariable risk-adjusted mortality was similar in both sexes, mainly attributable to lower blood urea nitrogen, higher LVEF, and higher systolic blood pressure in women compared with men.
  
  
  CONCLUSIONS
  Women with acute heart failure present with a clinical profile different from that of men, with more hypertension, diabetes, and depression, and a preserved LVEF. During hospitalization, they were less intensively diuresed. Nevertheless, risk-adjusted 180-day outcome was similar between sexes.
authors.affiliation: University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sven
authors.initials: S
authors.lastname: Meyer
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bloomfield
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.forename: Howard C
authors.initials: HC
authors.lastname: Dittrich
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D015897:Comorbidity; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004232:Diuretics / Q000494:pharmacology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012737:Sex Factors; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D004232:Diuretics
keywords: Acute heart failure; Aetiology; Biomarkers; Mortality; Sex