Baseline characteristics of women and men with HF, women with and without HF, and comparison of women with HFrEF and HFpEF are listed in Tables 1, 2, and 3. Among the 1006 patients admitted to CCU in 1 year, 345(34.2%) patients were females and 118 (34.2%) had evidence of HF, whereas 661 (65.7%) were males; 178 (26.9%) of them had HF. Regarding the HF type, in women, 73 (61.9%) had HFrEF versus 113 (63.5%) in men, P = 0.345, while 45 (38.1%) had HFpEF versus 65 (36.5%) in men, P = 0.378.
Comparison between women and men with HF
Women with HF were older in age, more obese, and less symptomatic than men. Women had higher incidence of associated comorbidities like liver failure, respiratory failure, and cellulitis. On the contrary, the prevalence of smoking, addiction, and previous MI and PCI were lower in women than in men. Women are less liable to be repeatedly admitted to the hospital for HF and less likely to have ischemic heart disease as underling etiology of HF. However, valvular heart diseases (VHD), atrial fibrillation (AF), and cardiomyopathies were more likely to be the etiologies of their HF (Fig. 2).
Accordingly, with the lower prevalence of coronary heart disease, women were less likely to undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Meanwhile, women treated with implantable cardioverter defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) and cardiac pacemakers at similar frequencies as men with HF.
Compared to men, women with HF had more normal ECG: 36 (30.5%) versus 36 (20.2%) P < 0.01, more prevalence of left anterior hemiblock (LAH) 5 (4.2%) versus 2 (1.1%) P < 0.02, AF 30 (25.4%) versus 30 (16%) P < 0.04, and less likely to have LBBB 15 (12.7%) versus 60 (33.7%), P < 0.00001. Regarding echocardiographic data, women had higher EF% 47 ± 13 versus 40 ± 13, P < 0.05 and smaller LA size 18.18 ± 18 versus 22.69 ± 19, P < 0.04; nevertheless, there was no considerable difference between women and men in grades of diastolic dysfunction, severity of mitral regurg, RWMA or E/e' (P = NS), or routine laboratory workup.
There was no significant difference in medications of invasive procedures like central venous pressure (CVP), endotracheal intubation, pacemakers, or ventilation prescribed during CCU admission between women and men.
Women with HF showed shorter stay in CCU compared to men. The mortality risk during hospitalization did not differ by gender (Fig. 3).
Comparison between women with and without HF
Comparing the 118 females with HF to 277 patients without HF (Table 2), HF females were older, more obese with higher BMI, had prevalent prior MI, with more PCI, CABG, and valve surgery. Females with HF had a higher prevalence of STEMI, NSTEMI/UA, pulmonary embolism (PE), infective endocarditis (IE), and aortic dissection and higher incidence of significant arrhythmias like AF and CHB. More hemodynamic compromise is recorded in HF female’s subgroup including higher heart rate and more hypotension. Additionally, women with HF had more frequent associated comorbidities, hepatic diseases, GIT bleeding, CVD, dementia, respiratory failure, peptic ulcer, and pneumonia. However, non-HF women had higher prevalence of cancer and autoimmune diseases.
On ECG, women with HF had higher prevalence of voltage criteria 14 (11.9%) versus 1 (0.44%), P < 0.0001, AF [30(25%) versus 11(4%)] P < 0.0001 pathologic Q wave 36 (30.5%) versus 62 (22.4%) P < 0.0001 compared to non-HF subgroup.
Regarding laboratory workup, women with HF had higher LDL level (154.15 ± 38 versus 140.88 ± 33 mg/dl, P < 0.01), FBS (209.66 ± 145 versus 149.76 ± 108 mg/dl, P < 0.001) higher A1c level 9.03 ± 2 versus 7.83 ± 3, P < 0.001, higher creatinine level (2.24 ± 3.2 versus 1.41 ± 1 mg/dl), ALT (65.7 ± 68 versus 42.41 ± 34 u, P < 0.0001) and higher INR ratio (1.54 ± 1 versus 1.21 ± 1, mg/dl, P < 0.001), lower hemoglobin (10.96 ± 3 versus12.00 ± 1, gm/dl P < 0.0001) and albumin (3.86 ± 1 versus 4.03 ± 1 mg/dl, P < 0.001.
The higher risk profile of women with HF is associated with increased mortality risk despite similar duration of hospital stay.
HFrEF and HFpEF in women
Unexpectedly, HFrEF was the commonest type of HF 73 (61.9%) versus HFpEF 45 (38.1%) in females (P < 0.001); the averaged value of EF was 33.88% in patients with reduced EF, while it was within the normal range for patients with preserved EF (61.4%) (Table 4). Comparing patients with reduced EF, to patients with preserved EF, they were significantly younger, had prevalent hypertension, more UA/NSTEMI, less STEMI and CABG, and less valve surgery. The causes of HF were ACS in a larger percentage of patients with reduced EF, where hypertensive heart disease and valvular HD were more common in those with preserved EF. Patients with reduced EF were also more likely to have frequent admission to hospital with CHF and more comorbidities like acute kidney injury (AKI) and COPD, while no difference in medications prescribed by CCU physicians between the two types. In contrast, mechanical ventilation, pacemakers, and CVP were higher in HFrEF. Clopidogrel, proton pump inhibitors (PPIH) and aspirin (ASA) were more commonly prescribed to HFrEF while calcium channel blockers (CCB) were more frequently prescribed to HFpEF (Table 5).
Regarding ECG changes, women with HFpEF had higher prevalence of voltage criteria, 13 (28.9%) versus 1 (0.4%) in HFrEF, P < .00001, but lower frequency of pathologic Q and ischemic changes, 14 (31%) versus 32 (43.8%) in HFrEF, P < 0.0001.
Patients with HFpEF illustrated shorter duration of hospital stay compared with those with HFrEF. However, HFrEF showed higher risk of mortality compared to HFpEF. Mortality was significantly higher in HFrEF 12% versus 1% in HF with HFpEF.