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Sex Differences Revealed: Heart Failure Death Rates

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Mortality rates in patients with heart failure are higher for women than men, as recently published in the Canadian Medical Association Journal.

In this study of Ontario residents from 2009 to 20014, the hospital admission rate for women with heart failure increased, whereas the hospital admission rate declined for men over the same period.

The researchers highlighted the importance of this work: “An in-depth understanding of these sex differences may help to increase awareness and lead to clinical trials to identify optimal monitoring and treatment strategies in women and men.”

In this retrospective cohort study, researchers inspected data from over 90 000 patients aged 40 years and older (47% women) over a 5 year period.

Despite substantial progress in heart failure management over the last decade, heart disease is still a major cause of illness and death, and accounts for 35% of total cardiovascular deaths in women. While there are some known sex-based differences in the risk factors, presentation and management of heart disease, further details of sex-differences in outcomes are needed.

The researchers identified many differences between men and women. Compared with men, women with heart failure were more likely to be frailer and older at diagnosis, and were more likely to have comorbid conditions including hypertension, pulmonary circulatory disease, COPD, hypothyroidism. In contrast, women were less likely to have myocardial infarction, liver disease, and atrial fibrillation.

Within a year after diagnosis, 17% of women died, compared with 15% of men. During the study period, hospitalization rates for women surpassed rates for men, with 98 per 1000 women hospitalized in 2013, compared with 91 per 1000 men.

The authors reflected on the findings, which “may reflect death being a competing risk for hospital admission in men. Alternatively, it possibly also reflects the underlying heart failure type.”

“Further studies should focus on sex differences in health-seeking behaviour, medical therapy and response to therapy to improve outcomes in women.”


Sun, L. Y., Tu, J. V., Coutinho, T., Turek, M., Rubens, F. D., Mcdonnell, L., . . . Mielniczuk, L. M. (2018). Sex differences in outcomes of heart failure in an ambulatory, population-based cohort from 2009 to 2013. Canadian Medical Association Journal, 190(28). doi:10.1503/cmaj.180177