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Women tend to be diagnosed with heart failure five years older than men, but have a better prognosis, finds research published in the European Journal of Heart Failure.

Aim: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time.
Patient characteristics:
Aged >45. New diagnosis of heart failure. Diagnosed between 1 January 2000 and 31 December 2017.
Number included 29234 men and 26725 women who were diagnosed with heart failure, including 15,084 men who died and 15822 women, within the study period of 17 years.
The median age of diagnosis was 74.8 for men, 79.6 for women.
The median survival following diagnosis was 4.47 years for men and 3.99 years for women. 
Cause of death in men: CVD (56.1%), primary heart failure (6.1%), heart failure any (41.8%) and non-CVD (43.9%).
Cause of death in women: CVD (55.2%), primary heart failure (8.4%), heart failure any (42.9%) and non-CVD (44.8%). 
Women had a 14% lower age-adjusted risk of all-cause mortality compared to men.
Logos - Oxford University NDPCHS, Wellcome, Funded by NIHR.

The researchers, from Oxford University’s Nuffield Department of Primary Care Health Sciences, analysed routinely collected health records from 26,725 women and 29,234 men aged over 45 years with a new diagnosis of heart failure between 2000 and 2017.

Commenting on the analysis, lead author Dr Clare Taylor, NIHR Academic Clinical Lecturer and GP, said: "It’s important to look at the differences in men and women with heart failure. We already know that women are less likely to be investigated in accordance with guidelines and to receive evidence-based therapies. For the first time, we explored the long term survival of women using a large primary care dataset including over 25,000 women with heart failure". 

"We found women are five years older when they are diagnosed and while their survival compared to men is better, the improvements in survival seen in men over the last 20 years haven’t been seen for women. The women that have the best survival are those diagnosed in the community, rather than in hospital".

“Our research highlights the need to address gender differences in diagnosis and treatment to improve survival for both men and women”. 

Co-author, Dr Nicholas Jones, Wellcome Trust Doctoral Research Fellow and GP, added: “More research is needed to understand the extent to which these results may reflect differences in categories of heart failure. Women are more likely to develop heart failure with preserved ejection fraction, for which there remains limited treatment. In contrast, we know the therapies to treat heart failure with reduced ejection fraction, more common in men, can significantly improve outlook.

The study used data from the Clinical Practice Research Data Link, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. It was funded by the National Institute for Health Research CLAHRC Oxford and the Wellcome Trust.

Read more:

National trends in heart failure mortality in men and women, United Kingdom, 2007-2017
Taylor CJ, Ordóñez‐Mena  JM, Jones NR, Roalf AK, Lay-Flurrie S, Marshall T, Hobbs RFD
European Journal of Heart Failure https://doi.org/10.1002/ejhf.1996