title: Sex Differences in the Management and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients Presenting to the Emergency Department With Acute Heart Failure.
abstract: BACKGROUND
  Heart failure (HF) with preserved ejection fraction (HFpEF) is more common in women than in men; data characterizing sex differences in the management and outcomes of HFpEF patients presenting to the emergency department (ED) are limited.
  
  
  RESULTS
  Using Acute Decompensated Heart Failure National Registry Emergency Module data linked to Medicare claims, we conducted a retrospective analysis of acute HF patients in the ED, identifying HFpEF (ejection fraction [EF] ≥40%) patients and stratifying by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and post-discharge outcomes. Of 4161 HFpEF patients, 2808 (67%) were women, who were more likely to be older and hypertensive, but less likely to be diabetic or smokers (all P < .01). Women more often presented with systolic blood pressure >140 mm Hg (62.5% vs 56.4%; P = .0001) and higher EF. There were no sex differences in ED therapies, adjusted 30- and 180-day all-cause mortality, in-hospital mortality, or 30- and 180-day readmissions. After adjustment, women had longer LOS (0.40 days, 95% confidence interval [CI] 0.10-0.70; P = .008).
  
  
  CONCLUSIONS
  Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to those in men. We observed adjusted differences in hospital LOS, but no differences in 30- and 180-day outcomes.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Reka
authors.initials: R
authors.lastname: Zsilinszka
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Peter
authors.initials: P
authors.lastname: Shrader
authors.affiliation: Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: N Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.affiliation: Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina. Electronic address: adrian.hernandez@duke.edu.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Heart failure with preserved ejection fraction; sex differences in management; sex differences in outcomes