Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis†
- Manuel Martínez-Sellés1,*,
- Robert N. Doughty2,
- Katrina Poppe2,
- Gillian A. Whalley3,
- Nikki Earle2,
- Christophe Tribouilloy4,
- John J.V. McMurray5,
- Karl Swedberg6,
- Lars Køber7,
- Colin Berry5,
- Iain Squire8 and
- on behalf of the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC)
+ Author Affiliations
- 1Cardiology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 16, 28007 and Universidad Europea de Madrid, Spain
- 2The University of Auckland, Department of Medicine, Auckland, New Zealand
- 3Unitec, Auckland, New Zealand
- 4INSERM, ERI 12, Amiens, France and University Hospital Amiens, France
- 5University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
- 6Sahlgrenska Academy, University of Gothenburg, Department of Emergency and Cardiovascular Medicine, Gothenburg, Sweden
- 7Rigshospitalet–Copenhagen University Hospital, Copenhagen, Denmark
- 8University of Leicester and NIHR Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- Received November 4, 2011.
- Revision requested January 30, 2012.
- Accepted February 3, 2012.
Aim The aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences in prognosis between men and women.
Methods and results Data from 31 studies (41 949 patients; 28 052 men, 13 897 women) from the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) individual patient meta-analysis were used. We performed survival analysis to assess the association of gender with mortality, adjusting for predictors of mortality, including age, reduced or preserved ejection fraction (EF), and ischaemic or non-ischaemic aetiology. Women were older [70.5 ( standard deviation 12.1) vs. 65.6 (standard deviation 11.6) years], more likely to have a history of hypertension (49.9% vs. 40.0%), and less likely to have a history of ischaemic heart disease (46.3% vs. 58.7%) and reduced EF (62.6% vs. 81.6%) compared with men. During 3 years follow-up, 3521 (25%) women and 7232 (26%) men died. After adjustment, male gender was an independent predictor of mortality, and the better prognosis associated with female gender was more marked in patients with heart failure of non-ischaemic, compared with ischaemic, aetiology (P-value for interaction = 0.03) and in patients without, compared with those with, diabetes (P-value for interaction <0.0001).
Conclusion This large, individual patient data meta-analysis has demonstrated that survival is better for women with heart failure compared with men, irrespective of EF. This survival benefit is slightly more marked in non-ischaemic heart failure but is attenuated by concomitant diabetes.