Gender Differences in Advanced Heart Failure

Insights from the BEST Study

Jalal K. Ghali, Heidi J. Krause-Steinrauf, Kirkwood F. Adams, Steven S. Khan, Yves D. Rosenberg, Clyde W. Yancy, James B. Young, Steven Goldman, Mary Ann Peberdy, Joann Lindenfeld

Research output: Contribution to journalArticle

196 Citations (Scopus)

Abstract

OBJECTIVES: The goal of this study was to determine the influence of gender on baseline characteristics, response to treatment, and prognosis in patients with heart failure (HF) and impaired left ventricular ejection fraction (LVEF). BACKGROUND: Under-representation of women in HF clinical trials has limited our understanding of gender-related differences in patients with HF. METHODS: The impact of gender was assessed in the Beta-Blocker Evaluation of Survival Trial (BEST) which randomized 2,708 patients with New York Heart Association class III/IV and LVEF ≤0.35 to bucindolol versus placebo. Women (n = 593) were compared with men (n = 2,115). Mean follow-up period was two years. RESULTS: Significant differences in baseline clinical and laboratory characteristics were found. Women were younger, more likely to be black, had a higher prevalence of nonischemic etiology, higher right and left ventricular ejection fraction, higher heart rate, greater cardiothoracic ratio, higher prevalence of left bundle branch block, lower prevalence of atrial fibrillation, and lower plasma norepinephrine level. Ischemic etiology and measures of severity of HF were found to be predictors of prognosis in women and men. However, differences in the predictive values of various variables were noted; most notably, coronary artery disease and LVEF appear to be stronger predictors of prognosis in women. In the nonischemic patients, women had a significantly better survival rate compared with men. CONCLUSIONS: In HF patients with impaired LVEF, significant gender differences are present, and the prognostic predictive values of some variables vary in magnitude between women and men. The survival advantage of women is confined to patients with nonischemic etiology.

Original languageEnglish (US)
Pages (from-to)2128-2134
Number of pages7
JournalJournal of the American College of Cardiology
Volume42
Issue number12
DOIs
StatePublished - Dec 17 2003
Externally publishedYes

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Heart Failure
Stroke Volume
Survival
Bundle-Branch Block
Atrial Fibrillation
Coronary Artery Disease
Norepinephrine
Survival Rate
Heart Rate
Placebos
Clinical Trials

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Ghali, J. K., Krause-Steinrauf, H. J., Adams, K. F., Khan, S. S., Rosenberg, Y. D., Yancy, C. W., ... Lindenfeld, J. (2003). Gender Differences in Advanced Heart Failure: Insights from the BEST Study. Journal of the American College of Cardiology, 42(12), 2128-2134. https://doi.org/10.1016/j.jacc.2003.05.012

Gender Differences in Advanced Heart Failure : Insights from the BEST Study. / Ghali, Jalal K.; Krause-Steinrauf, Heidi J.; Adams, Kirkwood F.; Khan, Steven S.; Rosenberg, Yves D.; Yancy, Clyde W.; Young, James B.; Goldman, Steven; Peberdy, Mary Ann; Lindenfeld, Joann.

In: Journal of the American College of Cardiology, Vol. 42, No. 12, 17.12.2003, p. 2128-2134.

Research output: Contribution to journalArticle

Ghali, JK, Krause-Steinrauf, HJ, Adams, KF, Khan, SS, Rosenberg, YD, Yancy, CW, Young, JB, Goldman, S, Peberdy, MA & Lindenfeld, J 2003, 'Gender Differences in Advanced Heart Failure: Insights from the BEST Study', Journal of the American College of Cardiology, vol. 42, no. 12, pp. 2128-2134. https://doi.org/10.1016/j.jacc.2003.05.012
Ghali JK, Krause-Steinrauf HJ, Adams KF, Khan SS, Rosenberg YD, Yancy CW et al. Gender Differences in Advanced Heart Failure: Insights from the BEST Study. Journal of the American College of Cardiology. 2003 Dec 17;42(12):2128-2134. https://doi.org/10.1016/j.jacc.2003.05.012
Ghali, Jalal K. ; Krause-Steinrauf, Heidi J. ; Adams, Kirkwood F. ; Khan, Steven S. ; Rosenberg, Yves D. ; Yancy, Clyde W. ; Young, James B. ; Goldman, Steven ; Peberdy, Mary Ann ; Lindenfeld, Joann. / Gender Differences in Advanced Heart Failure : Insights from the BEST Study. In: Journal of the American College of Cardiology. 2003 ; Vol. 42, No. 12. pp. 2128-2134.
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abstract = "OBJECTIVES: The goal of this study was to determine the influence of gender on baseline characteristics, response to treatment, and prognosis in patients with heart failure (HF) and impaired left ventricular ejection fraction (LVEF). BACKGROUND: Under-representation of women in HF clinical trials has limited our understanding of gender-related differences in patients with HF. METHODS: The impact of gender was assessed in the Beta-Blocker Evaluation of Survival Trial (BEST) which randomized 2,708 patients with New York Heart Association class III/IV and LVEF ≤0.35 to bucindolol versus placebo. Women (n = 593) were compared with men (n = 2,115). Mean follow-up period was two years. RESULTS: Significant differences in baseline clinical and laboratory characteristics were found. Women were younger, more likely to be black, had a higher prevalence of nonischemic etiology, higher right and left ventricular ejection fraction, higher heart rate, greater cardiothoracic ratio, higher prevalence of left bundle branch block, lower prevalence of atrial fibrillation, and lower plasma norepinephrine level. Ischemic etiology and measures of severity of HF were found to be predictors of prognosis in women and men. However, differences in the predictive values of various variables were noted; most notably, coronary artery disease and LVEF appear to be stronger predictors of prognosis in women. In the nonischemic patients, women had a significantly better survival rate compared with men. CONCLUSIONS: In HF patients with impaired LVEF, significant gender differences are present, and the prognostic predictive values of some variables vary in magnitude between women and men. The survival advantage of women is confined to patients with nonischemic etiology.",
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AU - Rosenberg, Yves D.

AU - Yancy, Clyde W.

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