Female sex and survival in patients hospitalized with acute heart failure and renal dysfunction

Background
Kidney dysfunction increases the risk of outcomes in patients hospitalized for acute heart failure (AHF). Female sex is associated with better outcomes in kidney dysfunction. The effect of female sex on outcomes in AHF patients with kidney dysfunction remains unclear.Methods And Results
This study included Western European and central Asian AHF patients with kidney dysfunction defined as an estimated glomerular filtration rate (eGFR) <90 ml/min. Primary endpoint was 1-year all-cause mortality (ACM), the secondary endpoint was a composite of first HF-related rehospitalization or ACM at 1 year. Overall, 1470 patients were included (46.2 % women, mean age 75.9 ± 12.2 years). Left ventricular ejection fraction was reduced in 40.3 % (n = 593), mildly reduced in 18.9 % (n = 278), and preserved in 40.7 % (n = 599) of study patients. The prevalence of female vs. male sex differed between HF subgroups (HFrEF: 28.3 vs. 50.7 %, HFmrEF: 18.9 vs. 19.0 %; HFpEF: 52.9 vs. 30.3 %, respectively; overall p < 0.001). In multivariable logistic regression analysis adjusted on age among other variables, female sex was associated with a significantly lower risk of 1-year ACM (odds ratio: 0.61, 95 % CI:0.47-0.79, p < 0.001) in all patients as well as in eGFR subgroups (<45 and ≥ 45 ml/min; p = 0.009 and p = 0.030, respectively). No significant association was found between sex and the secondary endpoint (odds ratio 0.83, 95 % CI: 0.66-1.04, p = 0.11).Conclusion
In this real-world cohort of HF patients prospectively enrolled across two different countries, the risk of 1-year ACM was lower among women with AHF and kidney dysfunction.