Do gender differences matter in Acute Heart Failure? Insights from Indian College of Cardiology – National Heart Failure Registry, India

Abstract

Background

Real-world investigations focused on gender-associated characteristics of Acute Heart failure (AHF) are lacking. The current study, from a national heart failure registry, aims to investigate gender-based patterns and outcomes among AHF patients in India.

Methods

This prospective Indian College of Cardiology National Heart Failure Registry enrolled patients admitted with AHF in 17 centres from 2019 to 2021. Demographics, aetiology, co-morbidities, laboratory investigations, electrocardiogram, and echo parameters were captured. In-hospital 30-day and one-year mortality rates were recorded. The prescription and adherence to the three Guideline Directed Medical Therapy (GDMT) prescription in 2019–2021 were also captured at discharge. Mortality rate Gender-based comparisons were tested at a 5 % level of significance.

Results

The study enrolled 5182 AHF patients, 66.7 % male (M) and 33.3 % female (F). The mean age of the male (M) population was 60.9 ± 13.3, and the female (F) population was 62.8 ± 14 years. Women had a higher prevalence of heart failure with preserved ejection fraction (HFpEF)(F:12.9 %, M:7.3 %;P < 0.0001), hypertension (F: 57.2 %, M: 52.4 %; P = 0.0011) and arrhythmia (F:15.2 %, M:11.7 %;P = 0.0005). Men had a higher incidence of ischemic heart disease (M:76.2 %, F:67.5 %; P < 0.001). Adherence to Renin-angiotensin-aldosterone system (RAAS) inhibitors, Beta-blockers and Mineralocorticoid receptor antagonists (MRAs) was low (18.8 % (M); 15.9 % (F)). The mortality rate, in-hospital mortality was 6.9 % (M:6.5 %, F:7.7 %), up to one-month was 11.8 % (M:11.6 %, F:12.3 %) or one-year was 18.1 % (M:17.8 %, F:18.6 %).

Conclusion

Women represent one-third of the population with AHF. Hypertension and HFpEF were more common in women, while ischemic heart disease was more prevalent in men. No gender-based differences were observed in the mortality outcomes. Both groups had low GDMT adherence. This calls for effective strategies to improve HF care in the country.