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Original research
Sex differences in heart failure hospitalisation risk following acute myocardial infarction
  1. Srikanth Yandrapalli1,
  2. Aaqib Malik1,
  3. Gayatri Pemmasani1,
  4. Wilbert Aronow1,
  5. Falak Shah1,
  6. Gregg Lanier1,
  7. Howard Cooper1,
  8. Diwakar Jain1,
  9. Srihari Naidu1,
  10. William Frishman2,
  11. Julio Panza1
  1. 1Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
  2. 2Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
  1. Correspondence to Dr Srikanth Yandrapalli, Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA; srikanth.yn{at}


Objective We evaluated the sex differences in 6-month heart failure (HF) hospitalisation risk in acute myocardial infarction (AMI) survivors.

Methods For this retrospective cohort analysis, adult survivors of an AMI between January and June 2014 were identified from the US Nationwide Readmissions Database. The primary outcome was a HF hospitalisation within 6 months. Secondary outcomes were fatal HF hospitalisation and the composite of index in-hospital HF or 6-month HF hospitalisation.

Results Of 237 549 AMI survivors, females (37.9%) were older (70±14 years vs 65±13 years; p<0.001), had a higher prevalence of cardiac comorbidities and a lower revascularisation rate compared with males. The primary outcome occurred in 12 934 patients (5.4%), at a 49% higher rate in females (6.8% vs 4.6% in males, p<0.001), which was attenuated to a 19% higher risk after multivariable adjustment. Findings were consistent across subgroups of age, AMI type and major risk factors. In the propensity-matched time-to-event analysis, female sex was associated with a 13% higher risk for 6-month HF readmission (6.4% vs 5.8% in males; HR 1.13, 95% CI 1.05 to 1.21, p<0.001), and the increased risk was evident early on after the AMI. Fatal HF rate was similar between groups (4.7% vs 4.6%, p=0.936), but females had a higher rate of the composite HF outcome (36.2% vs 27.5%, p<0.001).

Conclusion In a large all-comers AMI survivors’ cohort, females had a higher HF hospitalisation risk that persisted after adjustment for baseline risk differences. This was consistent across several clinically relevant subgroups and was evident early on after the AMI.

  • acute coronary syndrome
  • epidemiology
  • outcome assessment
  • health care
  • heart failure
  • risk factors

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  • SY and AM contributed equally.

  • Contributors SY and AM contributed equally to the design, analysis and writing of the manuscript. GP, WA, FS, GL, HC, DJ, SN, WF and JP participated in the development of the manuscript and provided critical feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data in the US Nationwide Readmissions Database are made publicly available by the Agency for Healthcare Research and Quality and the Healthcare Cost and Utilization Project.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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