AIMS Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various regions of the world. METHODS AND RESULTS We analysed several AHF cohorts including GREAT registry (22 523 patients, mostly from Europe and Asia) and OPTIMIZE-HF (26 376 patients from the USA). Clinical characteristics and medication use at discharge were collected. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model with adjustment for baseline characteristics (e.g. age, comorbidities, clinical and laboratory parameters at admission, left ventricular ejection fraction). In the GREAT registry, women had a lower risk of death in the year following AHF [HR 0.86 (0.79-0.94), P < 0.001 after adjustment]. This was mostly driven by northeast Asia [n = 9135, HR 0.76 (0.67-0.87), P < 0.001], while no significant differences were seen in other countries. In the OPTIMIZE-HF registry, women also had a lower risk of 1-year death [HR 0.93 (0.89-0.97), P < 0.001]. In the GREAT registry, women were less often prescribed with a combination of angiotensin-converting enzyme inhibitors and beta-blockers at discharge (50% vs. 57%, P = 0.001). CONCLUSION Globally women with AHF have a lower 1-year mortality and less evidenced-based treatment than men. Differences among countries need further investigation. Our findings merit consideration when designing future global clinical trials in AHF.

中文翻译：

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不同地理区域急性心力衰竭患者远期结局与生物学性别的相关性

AIMS 最近来自国家登记处的数据表明，男性和女性的急性心力衰竭 (AHF) 结果可能不同，但是，尚不清楚这一观察结果是否具有普遍性。本研究的目的是评估世界不同地区 AHF 患者的生物学性别与 1 年全因死亡率之间的关联。方法和结果 我们分析了几个 AHF 队列，包括 GREAT 登记（22523 名患者，主要来自欧洲和亚洲）和 OPTIMIZE-HF（来自美国的 26376 名患者）。收集出院时的临床特征和药物使用情况。使用 Cox 比例风险回归模型计算根据生物学性别的 1 年死亡率的风险比 (HR)，并调整基线特征（例如年龄、合并症、入院时的临床和实验室参数、左心室射血分数）。在 GREAT 登记中，女性在 AHF 后一年的死亡风险较低 [HR 0.86 (0.79-0.94)，调整后 P < 0.001]。这主要是由东北亚驱动的 [n = 9135, HR 0.76 (0.67-0.87), P < 0.001]，而在其他国家没有发现显着差异。在 OPTIMIZE-HF 注册中，女性的 1 年死亡风险也较低 [HR 0.93 (0.89-0.97), P < 0.001]。在 GREAT 登记中，女性出院时较少使用血管紧张素转换酶抑制剂和 β 受体阻滞剂的组合（50% 对 57%，P = 0.001）。结论在全球范围内，与男性相比，患有 AHF 的女性具有更低的 1 年死亡率和更少的循证治疗。国家之间的差异需要进一步调查。