Sex differences in patients with advanced heart failure: an analysis of the HELP-HF registry

Introduction Sex differences are reported in patients with heart failure (HF), but gaps remain in clinical practice and evidence, in particular, in those with advanced HF.Methods The HELP-HF registry enrolled consecutive patients with HF and at least one high-risk 'I NEED HELP' marker, evaluated at four Italian centres between 1 January 2020 and 30 November 2021. Patients' characteristics and outcomes were compared in men vs women. The primary endpoint was the composite of all-cause mortality or first HF hospitalization.Results A total of 1149 patients were included (mean age 75.1 +/- 11.5 years, median left ventricular ejection fraction 35%). Among them, 773 patients (67.3%) were males. Males were younger, had more cardiovascular diseases and a lower left ventricular ejection fraction (32%, [interquartile range 25-45] vs 45% [interquartile range 30-55]), while females showed a higher prevalence of non-cardiac conditions, neurocognitive and depressive disorders. The 1-year rate of the primary composite endpoint was 43.2% in males and 43.1% in females (log-rank P = .857). Multivariable analysis confirmed the lack of a significant impact of sex on the primary endpoint (adjusted hazard ratio 1.03, 95% confidence interval 0.85-1.27, P = .740). No significant differences were also observed in men vs women for the individual endpoints.Conclusions In our registry enrolling patients with markers of advanced HF, despite differences in clinical and echocardiographic characteristics, no sex-related differences in clinical outcomes were observed.