Gender differences in survival in advanced heart failure. Insights from the FIRST study.

Journal Article (Clinical Trial;Journal Article)

BACKGROUND: Previous natural history studies in broad populations of heart failure patients have associated female gender with improved survival, particularly in patients with a nonischemic etiology of ventricular dysfunction. This study investigates whether a similar survival advantage for women would be evident among patients with advanced heart failure. METHODS AND RESULTS: The study analysis is based on the Flolan International Randomized Survival Trial (FIRST) study which enrolled 471 patients (359 men and 112 women) who had evidence of end-stage heart failure with marked symptoms (60% NYHA class IV) and severe left ventricular dysfunction (left ventricular ejection fraction 18+/-4.9%). A Cox proportional-hazards model, adjusted for age, gender, 6-minute walk, dobutamine use at randomization, mean pulmonary artery blood pressure, and treatment assignment, showed a significant association between female gender and better survival (relative risk of death for men versus women was 2.18, 95% CI 1.39 to 3.41; P<0.001). Although formal interaction testing was negative (P=0.275), among patients with a nonischemic etiology of heart failure, the relative risk of death for men versus women was 3.08 (95% CI 1.56 to 6.09, P=0.001), whereas among those with ischemic heart disease, the relative risk of death for men versus women was 1.64 (95% CI 0.87 to 3.09, P=0.127). CONCLUSIONS: Women with advanced heart failure appear to have better survival than men. Subgroup analysis suggests this finding is strongest among patients with a nonischemic etiology of heart failure.

Full Text

Duke Authors

Cited Authors

  • Adams, KF; Sueta, CA; Gheorghiade, M; O'Connor, CM; Schwartz, TA; Koch, GG; Uretsky, B; Swedberg, K; McKenna, W; Soler-Soler, J; Califf, RM

Published Date

  • April 13, 1999

Published In

Volume / Issue

  • 99 / 14

Start / End Page

  • 1816 - 1821

PubMed ID

  • 10199877

Pubmed Central ID

  • 10199877

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

Digital Object Identifier (DOI)

  • 10.1161/01.cir.99.14.1816


  • eng

Conference Location

  • United States