The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M671-M672 (2003)
© 2003 The Gerontological Society of America
SEX-RELATED DIFFERENCE IN LONG-TERM MORTALITY IN ELDERLY HEART FAILURE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION
Ali Ahmed, MD, MPH and
Richard M. Allman, MD
University of Alabama at Birmingham Veterans Affairs Medical Center and Alabama Quality Assurance Foundation Birmingham, Alabama
To the Editor:
We read with great interest the article of Ibrahim and colleagues that describes similar mortality rates for elderly male and female patients with preserved left ventricular systolic function (1). In older adults with heart failure and left ventricular systolic dysfunction, we previously reported that compared to male patients, female patients had lower mortality rates (2). We have also reported that the mortality rate of elderly heart failure patients with preserved left ventricular systolic function was lower than that of patients with left ventricular systolic dysfunction (3). Using patients described in this latter study (3), we performed a Kaplan-Meier survival analysis to determine the bivariate association between gender and 4-year mortality among elderly heart failure patients with preserved left ventricular systolic function (n = 200). Patients had a mean (±SD) age of 78 (±7.8) years. Of the 200 patients, 69% were female, 14% were African American, and 57% died within 4 years of hospital discharge. Female patients had a mean of 143 days of longer 4-year survival than their male counterparts that was not statistically significant (Figure 1). No racial differences in the mortality rates were observed. When we adjusted for other covariates (age, race, admission from a nursing home, prevalent heart failure, discharge use of an angiotensin-converting enzyme inhibitor, 3 or more comorbidities, care by a cardiologist and hospital) in a multivariable Cox proportional hazards model, female gender was associated with a significant 41% reduction in the risk of 4-year mortality (adjusted hazard ratio = 0.59; 95% confidence interval = 0.38–0.90). African American race was associated with a 35% nonsignificant lower risk of 4-year death (adjusted hazards ratio = 0.65; 95% confidence interval = 0.34–1.23). Figure 2 demonstrates the survival curves by gender adjusted for means of the covariates. Even though in our study survival differences were not statistically significant at 18 months, a clear trend for better survival for female patients emerged early on during the follow-up. In a patient population apparently similar to that described by Ibrahim and colleagues, we observed that female gender was associated with a significant independent long-term survival benefit. Studies of mortality in heart failure patients with preserved left ventricular systolic function (vs those with left ventricular systolic dysfunction) have demonstrated similar variability in mortality rates (4–7). These are likely due to differences in study methodologies and/or other unmeasured covariates.
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Figure 1. Kaplan-Meier curves for 4-year postdischarge survival of older adults with heart failure and preserved left ventricular systolic function by gender
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Figure 2. Curves for 4-year postdischarge survival adjusted for means of covariates for older adults with heart failure and preserved left ventricular systolic function by gender
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Acknowledgments
Dr. Ahmed is partly supported by a career development grant from the Southeast Center of Excellence in Geriatric Medicine.
Address correspondence to Ali Ahmed, MD, Division of Geriatric Medicine and Geriatric Heart Failure Clinic, University of Alabama at Birmingham, Section of Geriatrics, and Geriatric Heart Failure Clinic, Birmingham VA Medical Center, 1530 3rd Ave South, CH19-219, Birmingham, AL 35294-2041. E-mail: aahmed{at}uab.edu
The analyses upon which this publication is based were performed under Contract Number 500-96-P60, entitled "Utilization and Quality Control Peer Review Organization for the State of Alabama," sponsored by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (DHHS). The content of this publication does not necessarily reflect the views or policies of the DHHS, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
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- Ahmed A, Allman RM, DeLong JF. Sex-related variation in the quality and outcomes of care of older adults with heart failure. Am J Geriatr Cardiol.. 2002;11:133.
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