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. 2024 Jan 5:10:1257335.
doi: 10.3389/fcvm.2023.1257335. eCollection 2023.

Sex differences in mortality and hospitalization in heart failure with preserved and mid-range ejection fraction: a systematic review and meta-analysis of cohort studies

You Deng #  1 , Jun Zhang #  2 , Jitao Ling #  3 , Qingwen Hu  3 , Tianggang Song  3 , Yi Xu  3 , Menglu Liu  4 , Yuting Wu  3 , Kaibo Mei  3 , Jiawei Chen  3 , Huilei Zhao  5 , Xiao Liu  6
Affiliations

Sex differences in mortality and hospitalization in heart failure with preserved and mid-range ejection fraction: a systematic review and meta-analysis of cohort studies

You Deng et al. Front Cardiovasc Med. .

Abstract

Introduction: The influence of sex on the prognosis of heart failure with preserved or intermediate ejection fraction (HFpEF and HFmrEF) remains uncertain. This study aimed to investigate whether sex differences impact the prognosis of patients diagnosed with HFpEF and HFmrEF.

Methods: A comprehensive search across three databases (PubMed, the Cochrane Library, and Embase) was conducted to identify sex-related prognostic cohort studies focusing on HFpEF and HFmrEF. Risk estimates were synthesized using the random effects model. The analysis included 14 cohorts comprising 41,508 HFpEF patients (44.65% males) and 10,692 HFmrEF patients (61.79% males).

Results: Among HFpEF patients, men exhibited significantly higher rates of all-cause mortality (13 studies; hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.15 to 1.33)) and cardiovascular disease mortality (5 studies; HR: 1.22, 95% CI: 1.14 to 1.31) compared to women. However, no significant difference was observed in HF admissions. For HFmrEF patients, men displayed notably higher all-cause mortality (HR: 1.21, 95% CI: 1.12 to 1.31) but no significant differences in cardiovascular mortality or HF admissions.

Discussion: These findings suggest that male patients diagnosed with HFpEF and HFmrEF may face a more unfavorable prognosis in terms of all-cause mortality. Variations were noted in cardiovascular mortality and HF admissions, indicating potential complexities in sex-related prognostic factors within these heart failure categories. In summary, male patients with HFpEF and HFmrEF may have a more unfavorable prognosis.

Keywords: HF; HFmrEF; HFpEF; meta-analysis; prognosis; sex.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study selection process in the meta-analysis of the association between sex differences and prognosis in patients with HFpEF and HFmrEF.
Figure 2
Figure 2
Forest plot of the association between sex differences and prognosis in patients with HFpEF. (A) Association between sex differences and all-cause mortality in patients with HFpEF. (B) Association between sex differences and CV mortality in patients with HFpEF. (C) Association between sex differences and HF admission in patients with HFpEF. In the forest plot, the diamond indicates the pooled estimate. Gray boxes are relative to study size, and the black vertical lines indicate 95% CIs around the effect size estimate. HFpEF, heart failure with preserved ejection fraction; CV, cardiovascular.
Figure 3
Figure 3
Forest plot of the association between sex differences and prognosis in patients with HFmrEF. (A) Association between sex differences and all-cause mortality in patients with HFmrEF. (B) Association between sex differences and CV mortality in patients with HFmrEF. (C) Association between sex differences and HF admission in patients with HFmrEF. HF, heart failure; HFmrEF, heart failure with mid-range ejection fraction; CV, cardiovascular.
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Grants and funding

This work was supported by Natural Science Foundation in Jiangxi Province grant [No. 202004BCJL23049 to PY].
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