Gender Difference in Prognosis of Patients with Heart Failure: A Propensity Score Matching Analysis

Abstract

Heart failure (HF) has been a global health concern with high prevalence, mortality and costs. A reliable prognostic prediction for HF was essential. Despite advances in predicting adverse outcomes in patients with HF, limited studies considered or specifically explored the effect of gender differences on prognosis. In this study, we estimated the gender differences in prognosis of patients with HF based on a propensity score matched cohort. Missing data were handled by a multiple imputation method using regression with predictive mean matching. Thereafter, propensity score matching (PSM) was performed with a single hidden layer neural network in a 1:1 matching (male vs. female). Totally, 730 patients with HF were enrolled in this study, (male: 399; female: 331). After PSM analysis, 364 patients were matched (male: 182; female: 182) and important prognostic factors including age, echocardiographic variables, and variables related to kidney function were balanced between female and male groups. This study demonstrated that female gender had better overall survival than that of male (hazard ratio of allcause mortality between female and male: 0.593; 95% confidence interval(CI), 0.353-0.996, p = 0.048) but prognosis conditions involving cardiovascular survival and HF-related readmission had no significant difference between male and female patients (cardiovascular mortality: hazard ratio: 0.669; 95%CI, 0.3111.443, p = 0.306; HF-related readmission: hazard ratio:0.828; 95%CI, 0.549-1.250, p = 0.370).