Abstract

Aim: To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms. Methods and Results: We report a secondary data analysis from 528 hospitalised individuals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction (HFrEF, HFmrEF, or HFpEF) who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated; with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12month follow-up, most KCCQ scores had not significantly changed. However, 25% of individuals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (p = 0.025). On an adjusted basis, women (OR 1.78, 95%CI 1.00-3.16 versus men), those with coronary artery disease (OR 2.01, 95%CI 1.21-3.31) and baseline acute pulmonary oedema (OR 1.67, 95%CI 1.02-2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR 2.16, 95%CI 1.07-4.35) and a non-English-speaking background (OR 2.30, 95%CI 1.02-5.20). Conclusion: We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalised with the syndrome.