Hospitalization for HF After Acute MI More Common in Women Than Men

In the months following an acute MI, women are significantly more likely than men to be readmitted for heart failure (HF), even if they did not have HF at the index admission, a new analysis of sex differences in survivors suggests.

Women were older and less likely than men to receive PCI or CABG for acute MI, and while those factors may set them up for HF admission, lead author Srikanth Yandrapalli, MD (Westchester Medical Center and New York Medical College, Valhalla, NY), noted that the findings suggest that the difference in risk emerges early in the weeks after discharge. The implication being that women may be more prone to inconsistent or incomplete follow-up than men during a vulnerable time.

In their paper, published online January 11, 2021, ahead of print in Heart, Yandrapalli and colleagues advocate for early, sex-targeted, post-acute MI follow-up care to identify a variety of issues that may increase the risk of HF hospitalization.

“There is prior research which showed that medication compliance for certain types of heart failure is lower for females. Also, disease awareness and symptom awareness [have been shown to be] lower in women than men, which might increase their risk of going into heart failure and requiring hospitalization,” Yandrapalli told TCTMD. “So, there are certain differences which may exist both in the pathophysiology, in how we provide care to our patients, in how patients perceive their disease processes, and maybe in how outpatient follow-up might be happening that [could be] causing these differences in outcomes.”

19% Higher HF Hospitalization at 6 Months

For the study, Yandrapalli et al examined data on 237,549 patients from the US Nationwide Readmissions Database treated between January and June 2014 who survived an acute MI, were discharged, and had follow-up data available for 6 months.

In addition to being older than men, women had more cardiac comorbidities but were less likely to have dyslipidemia, smoking history, or prior MI. While 69% of men received either PCI or CABG after admission for acute MI, only 49% of women were revascularized (P < 0.001).

Among the nearly one-third of patients who had HF on admission, more of them were women than men (34.3% vs 26.1%; P < 0.001). At 6 months postdischarge, 6.8% of women versus 4.6% of men were hospitalized for HF (P < 0.001). After multivariable adjustment, women still had a 19% higher odds of HF hospitalization. Sensitivity analyses confirmed the higher risk for women. This finding was consistent regardless of age, MI presentation, revascularization status, HF on index admission, and multiple CV risk factors.

The researchers also conducted a propensity-matched analysis of 147,808 patients, which again showed a significantly higher rate of 6-month hospitalization for HF in the female cohort (P = 0.007).

In a time-to-event analysis, there was early separation of the sex-specific Kaplan-Meier curves within the first 2 weeks after acute MI. While rates of death from HF were not different between men and women, the latter did have a higher combined risk of in-hospital HF during the index admission and 6-month readmission for HF (P < 0.001).

More Thoughtful Follow-up Approaches Needed

Nearly 20 years ago, the VALIANT trial of patients with acute MI and HF or LV systolic dysfunction suggested that HF hospitalization in the subsequent 2 years was more than 36% higher in women than men. Yandrapalli and colleagues say their study confirms “the persistence of these previously reported sex differences in a more contemporary cohort” and also extends the findings to those who do not have HF at the index acute MI.

To TCTMD, Yandrapalli said the new data suggest that although more work is needed to better understand both the sex differences and sex-specific risks that may not be modifiable, standard follow-up would benefit from a more thoughtful approach that takes advantage of current technology, whether it be a telehealth appointment or a simple phone call.

“Things like: ‘How are you feeling? Has anything changed? Have you been taking your medications? Do you have any issues? Are having any side effects?’ There are simple things that we can solve over the phone, and this can probably be done in the first week, because this is the highest-risk period,” Yandrapalli noted. In terms of resources, he added, that approach is likely to save money down the line if it prevents hospitalizations.