Gender-related dissociation in outcomes in chronic heart failure: Reduced mortality but similar hospitalization in women

Mustafa I. Ahmed, Mitja Lainscak, Marjan Mujib, Thomas E. Love, Inmaculada Aban, Ileana L. Piña, Wilbert S. Aronow, Vera Bittner, Ali Ahmed

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: The impact of gender on major natural history endpoints in heart failure (HF) has not been examined in a propensity-matched study. Methods: Of the 7788 chronic systolic and diastolic HF patients in the Digitalis Investigation Group trial 1926 were women. Propensity scores for female gender were used to assemble a cohort of 1669 pairs of men and women who were well-balanced on 32 measured baseline characteristics. Matched hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with female gender were calculated using stratified Cox regression models. Results: All-cause mortality occurred in 36% (rate, 1256/10,000 person-years) and 30% (rate, 1008/10,000 person-years) of matched men and women respectively during 5 years of follow up (HR when women were compared with men, 0.82, 95% CI, 0.72-0.94, P = 0.004). Female gender was also associated with reduced cardiovascular mortality (matched HR, 0.85; 95% CI, 0.73-0.99, P = 0.037) and a trend toward reduced non-cardiovascular mortality (matched HR, 0.73; 95% CI, 0.53-1.00; P = 0.053). All-cause hospitalization occurred in 67% (rate, 4003/10,000 person-years) and 65% (rate, 3762/10,000 person-years) matched male and female patients respectively (HR for women, 1.03, 95% CI, 0.93-1.15, P = 0.538). Female gender was not associated with cardiovascular or HF hospitalization but was associated with hospitalization due to unstable angina pectoris (matched HR, 1.38; 95%CI, 1.11-1.72; P = 0.003) and stroke (matched HR, 0.65; 95%CI, 0.46-0.92; P = 0.014). Conclusions: In patients with chronic HF, female gender has a significant independent association with improved survival but has no association with all-cause, cardiovascular, or HF hospitalizations.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalInternational Journal of Cardiology
Issue number1
StatePublished - Apr 1 2011
Externally publishedYes


  • Gender
  • Heart failure
  • Hospitalization
  • Mortality
  • Unstable angina pectoris

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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