Clinical Presentation, Biomarker Trajectories, and Outcomes in Women and Men Hospitalized for Acute Heart Failure

Background: Previous studies have shown important but sometimes heterogeneous differences between women and men with heart failure (HF). Objectives: This study aims to investigate sex differences in the phenotype and journey of men and women in a large contemporary acute heart failure (AHF) cohort. Methods: The authors analyzed 6,545 AHF patients (40% women) enrolled in RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF). Results: Women were older (78 vs 72 years; P < 0.001) and had higher ejection fraction (45% vs 35%; P < 0.001). During hospitalization, women received lower diuretic doses (furosemide equivalent through day 5: 200 vs 240 mg intravenous; P < 0.001) and achieved lower weight loss (relative; P = 0.026), with slightly lower diuretic response (−0.33 vs −0.36 kg/40 mg furosemide at day 5; P = 0.011) and similar sign and symptom improvement by day 5 compared with men (all adjusted P > 0.05). More women experienced worsening renal function by day 5 (WRF; adjusted HR: 1.24 [95% CI: 1.06-1.46]; P = 0.009). Women experiencing WRF had increased risk of 180-day cardiovascular death and rehospitalizations for HF or renal failure (RF) and of rehospitalizations for HF/RF compared with men and women without WRF (adjusted P for interaction: P < 0.001). Incidence of other outcomes was similar in women and men (all P > 0.2). Conclusions: During an AHF hospitalization, women received lower doses of loop diuretic agents and achieved less weight loss with slightly lower diuretic response compared with men, despite similar symptom relief and postdischarge outcomes. Early incident WRF was more frequent in women and was associated with worse 180-day outcomes. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778)