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The following is a summary of “Sex and clinical outcomes in new-onset heart failure,” published in the March 2025 issue of the International Journal of Cardiology by Vicent et al. 

Sex-based differences in the presentation, management, and outcomes of heart failure (HF) have been well-documented; however, data specifically addressing these variations in patients with new-onset acute HF remain limited. This study aims to assess the influence of sex on clinical characteristics, treatment approaches, and prognosis in patients hospitalized with newly diagnosed acute HF. The Spanish Network for the Study of Heart Failure III (REDINSCOR III) is a prospective registry that included consecutive adult patients admitted with new-onset acute HF. The primary endpoint was all-cause mortality at 12 months, with additional analyses focused on HF-related hospital readmissions. A total of 532 patients were included in the registry, of whom 178 (33.4%) were female. Compared to men, women were significantly older at the time of admission (mean age: 71.2 ± 13.1 vs. 65.7 ± 13.0 years, P < 0.001) and were more likely to live alone (24.9% vs. 12.1%, P = 0.001). 

Women also exhibited higher left ventricular ejection fraction (LVEF) (43.4 ± 15.2% vs. 37.2 ± 13.6%, P < 0.001) and had a lower prevalence of prior cardiovascular disease, including myocardial infarction (15.0% vs. 5.7%, P = 0.002) and peripheral arterial disease (8.0% vs. 2.3%, P = 0.010). During the 12-month follow-up period, 30 patients (5.6%) died. Mortality rates were comparable between women and men (5.6% vs. 5.7%, P = 0.988). Furthermore, female sex was not independently associated with all-cause mortality ([HR]: 0.77, 95% [CI]: 0.34–1.74, P = 0.540), HF readmission (HR: 1.29, 95% CI: 0.66–2.53, P = 0.451), or the composite outcome of death or HF readmission (HR: 0.98, 95% CI: 0.56–1.74, P = 0.972). Conversely, increasing age was significantly associated with higher all-cause mortality (HR: 4.32, 95% CI: 1.72–10.81, P = 0.002), and lower hemoglobin levels were also predictive of worse outcomes (HR: 0.98, 95% CI: 0.96–0.99, P = 0.006). These findings suggest that while there are notable sex-related differences in clinical presentation and baseline characteristics among patients with new-onset acute HF, sex does not appear to independently influence prognosis. Instead, traditional risk factors such as age and hemoglobin levels play a more significant role in determining long-term outcomes. Further studies with larger cohorts and longer follow-up periods are needed to explore potential sex-specific pathophysiological mechanisms and optimize personalized treatment strategies for both male and female patients with new-onset HF.

Source: internationaljournalofcardiology.com/article/S0167-5273(25)00135-4/abstract