Women’s Heart Failure Mortality Risk May Increase at Upper LVEF Extreme

highlighted red heart disease on woman body
Researchers sought to determine whether there were any sex-related differences in mortality risk in LVEF after admission for acute heart failure at 6-month follow-up.

No sex-related differences at 6-month follow-up were observed for all-cause mortality risk among men and women hospitalized for acute heart failure (HF), according to a study published in the Journal of the American Heart Association. However, women vs men may have a lower risk for cardiovascular- (CV) and HF-related mortality at the lower extreme of left ventricular ejection fraction (LVEF) and a higher risk for HF mortality at the upper extreme.

For the study, researchers retrospectively reviewed data from 4812 patients who were admitted to 3 hospitals in Spain for acute HF from January 2008 to October 2019. All participants received a 2-dimensional transthoracic echocardiogram during index hospitalization. Study endpoints included CV, HF, and all-cause death at 6 months of follow-up. Sex-related differences across LVEF were examined using multivariable Cox regression models.

Study participants had a mean age of 74.2±11.1 years; 46.6% were women; and 54.2% had LVEF greater than or equal to 50%.

By the 6-month follow-up mark, 13.4% of the participants had died (13.3% women, 13.5% men; P =.822). Of these deaths, 11.3% were CV-related, and 8.6% were HF-related. No independent association was identified between LVEF and all-cause mortality (hazard ratio [HR], 1.02; 95% CI, 0.99-1.05; P =.135). Multivariable adjustment revealed no sex-based differences in all-cause mortality (P =.168), but sex was significantly associated with both HF mortality risk (P =.007) and CV mortality risk (P =.030) across LVEF. Women vs men were at a significantly lower risk for HF and CV mortality at the lower LVEF extreme (LVEF <43% [HR, 0.77; 95% CI, 0.59-0.99] and <25%, respectively), but women were at a higher risk for HF mortality at the upper LVEF extreme (LVEF >80%).

Limitations to this study include an observational study design, a lack of early in-hospital deaths in the analysis, a lack of external review of echocardiographic studies, an inability to attribute the cause of death, a potential lack of generalizability to other ethnicities or geographical regions, and a lack of understanding of pathophysiological mechanisms underlying these findings.

“In this study, sex was not a determinant of 6-month all-cause mortality risk following a HF decompensation,” the study authors wrote. “However, we found a differential prognostic effect of sex across the LVEF spectrum for 6-month [CV] and HF mortality.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Santas E, Palau P, Llácer P, et al. Sex-related differences in mortality following admission for acute heart failure across the left ventricular ejection fraction spectrum. J Am Heart Assoc. Published online December 20, 2021. doi: 10.1161/JAHA.121.022404.