Gender Does Not Affect Postdischarge Outcomes in Patients Hospitalized for Worsening Heart Failure With Reduced Ejection Fraction (from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan [EVEREST] Trial)

Women have traditionally been underrepresented in heart failure (HF) trials, and their baseline characteristics and outcomes after hospitalization for HF are unclear. We retrospectively analyzed the clinical characteristics and outcomes of patients according to gender in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. EVEREST randomized 4,133 patients hospitalized for HF and ejection fraction of ≤40% to tolvaptan or placebo, in addition to standard therapy. The median follow-up was 9.9 months. Log-rank tests and multivariate Cox regression models were used to compare the hazards of all-cause mortality and cardiovascular mortality or HF hospitalization. Women constituted 1,058 (26%) of the study population. The baseline characteristics were similar except that the women were older with more hypertension and diabetes and less chronic renal insufficiency, previous myocardial infarction, previous coronary revascularization, and baseline defibrillator implantation (all p <0.001). The baseline use of evidence-based HF medical therapies was similar between genders (all p >0.30). Despite a high event rate, no difference was seen in all-cause mortality (men 27% vs women 24%, multivariate hazard ratio 1.04, p = 0.61) or cardiovascular mortality plus HF hospitalization (men 42% vs women 39%, multivariate hazard ratio 1.11, p = 0.10) on univariate analysis or after adjusting for baseline covariates. In conclusion, women hospitalized for worsening HF with an ejection fraction of ≤40% were older, had more hypertension, and had received fewer procedure-based interventions than men but had relatively similar HF medication usage and clinical findings. After hospitalization for HF, women have a similarly high risk of long-term HF morbidity and mortality compared with men.