Sex, race identified as potential factors for 1-year survival in HFpEF
Men hospitalized with HF with preserved ejection fraction experienced elevated risk for 1-year all-cause mortality compared with women, researchers reported.
Moreover, Black patients experienced better 1-year survival compared with white patients.
According to findings published in the Journal of the American Heart Association, age, heart rate, worsening renal function and low hemoglobin were associated with increased mortality regardless of sex or race.
However, higher BP was found to be protective among all subgroups while BMI was protective among men.
“HFpEF represents a major unmet need in cardiovascular medicine today, with ongoing efforts to identify clinical and mechanistic subgroups, or phenotypes, within HFpEF to better target therapies,” Kavita Sharma, MD, director of the Johns Hopkins Heart Failure with Preserved Ejection Fraction Program at Johns Hopkins Medicine, and colleagues wrote. “We sought to understand differences in sex and race in hospitalized patients with HFpEF from the community surveillance population of the ARIC study, a large sample that is unique in its geographic and racial diversity. We identified differences in patient characteristics and outcomes by sex and race in a diverse HFpEF population, which may help strategize targeted monitoring and management of HFpEF.”
For this assessment, investigators included 1,892 acute HFpEF hospitalizations (mean age, 77 years; 63% women; 23% Black).
All-cause mortality risk by sex
After a fully adjusted analysis, researchers found that men had a greater risk for all-cause mortality compared with women, within 1 year after HFpEF hospitalization (HR = 1.27; 95% CI, 1.06-1.52).
Independent risk factors for 1-year all-cause mortality among both men and women included:
- age (HR per 10-year increment in women = 1.33; 95% CI, 1.17-1.51; HR in men = 1.23; 95% CI, 1.05-1.44);
- heart rate (HR per 10 beats per minute in women = 1.05; 95% CI, 1.01-1.1; HR in men = 1.1; 95% CI, 1.03-1.17); and
- worse renal function (HR per 15 mL/min/1.73 m2 decrease in women = 1.19; 95% CI, 1.08-1.31; HR in men = 1.14; 95% CI, 1.01-1.27).
Elevated systolic BP was associated with lower mortality among both men and women (HR in women = 0.84; 95% CI, 0.6-1.16; HR in men = 0.91; 95% CI, 0.58-1.43).
In addition, elevated BMI was associated with lower all-cause mortality among men (OR in men = 0.82; 95% CI, 0.73-0.93), with borderline significance among women (OR in women = 0.96; 95% CI, 0.9-1.02).
All-cause mortality risk by race
Investigators observed that Black patients had lower risk for 1-year mortality after HFpEF hospitalization compared with white patients (HR = 0.79; 95% CI, 0.64-0.97).
Predictors of 1-year all-cause mortality in both races included age (HR per 10 years increment in white patients = 1.28; 95% CI, 1.14-1.44; HR in Black patients = 1.32; 95% CI, 1.12-1.55) and heart rate (HR per 10 beats per minute increment in white patients = 1.06; 95% CI, 1.02-1.1; HR for Black patients = 1.14; 95% CI, 1.06-1.21).
Factors associated with worse survival among white patients included atrial fibrillation (HR = 1.34; 95% CI, 1.09-1.56), chronic obstructive pulmonary disease (HR = 1.41; 95% CI, 1.15-1.72) and worse renal function (HR per 15 mL/min/1.73 m2 decrease = 1.2; 95% CI, 1.1-1.31).
Elevated BMI was associated with better 1-year survival among white patients (HR per 5 kg/m2 increment = 0.88; 95% CI, 0.81-0.95).
Moreover, elevated systolic BP was associated with improved 1-year all-cause mortality in both Black and white patients, with significant interaction by race (OR in white patients = 0.97; 95% CI, 0.94-1; OR in Black patients = 0.9; 95% CI, 0.85-0.95; P for interaction = .02).
“The paradoxical relationship between lower BP and poor prognosis is well established for patients with HF [with reduced] EF, and has been demonstrated in patients with HFpEF as well,” the researchers wrote. “More recently, this relationship has been described as a reverse J curve for both patients with HFpEF and those with HFrEF. Our finding of an interaction between BP and race in HFpEF is novel, and warrants further study.”