Sex Differences in New York Heart Association Functional Classification and Survival in Acute Heart Failure Patients With Preserved or Reduced Ejection Fraction.

Background: The aim of this study was to evaluate the influence of sex on the relationship between the New York Heart Association (NYHA) functional classification and survival in acute decompensated heart failure (HF) patients with preserved or reduced ejection fraction (EF).

Methods: Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4717 (2730 men and 1987 women) were investigated to assess the association of sex, NYHA functional class, and preserved or reduced EF with all-cause death. Men and women were divided into 6 groups based on left ventricular EF (preserved or reduced) and NYHA functional class (II, III, or IV) at admission.

Results: Among both sexes with preserved EF, multivariable analysis confirmed that NYHA functional class IV was associated with a significantly higher risk of all-cause death than NYHA functional class II. Similarly, in women with reduced EF, NYHA functional class IV was a significant predictor of all-cause death compared with class II. However, in men with reduced EF, the adjusted risk of all-cause death was similar for those in NYHA functional classes II, III, and IV. Furthermore, the interaction between sex and NYHA functional classes II to IV was statistically significant for all-cause death in reduced EF patients (P for interaction = 0.037), but not in preserved EF patients (P for interaction = 0.711).

Conclusions: NYHA functional class IV was a significant predictor of all-cause death in both sexes with preserved EF, whereas NYHA functional class IV was a significant predictor of all-cause death in women, but not in men, with reduced EF.