CLINICAL STUDY: HEART FAILURE
Gender, age, and heart failure with preserved left ventricular systolic function
Frederick A. Masoudi, MD, MSPH, FACC*  ,*,
Edward P. Havranek, MD, FACC*,
Grace Smith, MPH ,
Ronald H. Fish, MBA,
John F. Steiner, MD, MPH,
Diana L. Ordin, MD, MPH|| and
Harlan M. Krumholz, MD, FACC
* Denver Health Medical Center, Denver, Colorado, USA
University of Colorado Health Sciences Center, Denver, Colorado, USA
Colorado Foundation for Medical Care, Aurora, Colorado, USA
Yale University School of Medicine, New Haven, Connecticut, USA
|| Centers for Medicare and Medicaid Services, Boston, Massachusetts., USA
Manuscript received July 1, 2002;
revised manuscript received August 19, 2002,
accepted September 6, 2002.
* Reprint requests and correspondence: Dr. Frederick A. Masoudi, Division of Cardiology MC 0960, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA.
fred.masoudi{at}uchsc.edu
OBJECTIVES: This study was designed to determine if women are more likely than men to have heart failure (HF) with preserved systolic function after adjustment for potential confounders, including age.
BACKGROUND: Although prior evidence suggests an independent association between female gender and preserved left ventricular systolic function (LVSF) in patients with HF, existing studies are limited by referral biases, small sample sizes, or the inability to adjust for a wide range of potential confounding variables.
METHODS: This is a cross-sectional study using data from retrospective medical chart abstraction of a national sample of Medicare beneficiaries hospitalized with the principal discharge diagnosis of HF in acute-care nongovernmental hospitals in the U.S. between April 1998 and March 1999. Patients were eligible for this analysis if they were age 65 years or older, had documentation of LVSF, and corroboration of the diagnosis of HF. We used multivariable logistic regression to identify the correlates of preserved LVSF, which was defined as qualitatively normal function or quantitatively reported ejection fraction  0.50. Stratified regressions by gender were performed to identify significant interactions.
RESULTS: Of the 19,710 patients in the analysis, preserved LVSF was present in 6,700 (35%), 79% of whom were women. In contrast, among the 12,956 patients with impaired LVSF, only 49% were women. Patients with preserved LVSF were 1.5 years older than those with impaired LVSF. After adjustment for age and other patient factors, female gender remained strongly associated with preserved LVSF (calculated risk ratio = 1.71; 95% confidence interval 1.63 to 1.78). The association was consistent in all age groups, and was similar in patients with or without coronary artery disease, hypertension, pulmonary disease, renal insufficiency, or atrial fibrillation.
CONCLUSIONS: In elderly patients hospitalized with HF, preserved systolic function is primarily a condition of women, independent of important demographic and clinical characteristics.
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Abbreviations and Acronyms
| | HF | | heart failure | | LV | | left ventricular | | LVEF | | left ventricular ejection fraction | | LVSF | | left ventricular systolic function | | NHF | | National Heart Failure Project |
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