Clinical features and prognosis of heart failure in women. A 5-year prospective study.
Although heart failure (HF) is frequent and causes significant morbidity and mortality in women, data on the prognosis of women hospitalized for a first episode of HF are scarce. This study was designed to describe the clinical characteristics and treatment of HF in women and to assess the effect of gender on long-term survival. We prospectively included consecutive patients admitted for a first episode of HF in all healthcare establishments of the Somme department (France) during the year 2000. Baseline characteristics and long-term prognosis were evaluated and compared according to gender. 799 patients were included (389 women and 410 men). Women were older, had a higher prevalence of hypertension and renal insufficiency, and a lower prevalence of coronary artery disease. Prescription of HF medication at discharge was not significantly different between women and men. The prevalence of HF with preserved ejection fraction was higher in women. Five-year overall survival rates were not significantly different between women and men (39% vs. 41%, p=0.58). Cardiovascular mortality in women with HF was comparable with that observed in men. The 5-year survival in women was dramatically lower than the expected 5-year survival of the age-matched general population of women. On multivariable analysis, older age, cancer, stroke, diabetes, renal insufficiency, and lower natraemia were independent predictors of 5-year mortality in women. The prognosis after a first episode of HF in women is severe, comparable to that observed in men, with a 5-year survival rate of 39% and a dramatic excess mortality compared to the general population of women.