What is the clinical evidence from this study?

Study design: Cohort. Population: Left ventricular heart failure (n=2616462). Primary outcome: In-hospital mortality (OR 0.841 for female sex, 95% CI [0.833; 0.849], p=<0.001).

What question did this study set out to answer?

The study aims to examine how disease severity and outcomes of left ventricular heart failure differ between sexes.

February 25, 2026Open Access

Sex-specific differences in disease severity and outcomes in left ventricular heart failure: a nationwide cohort study

Q: What are the key findings of this study?

Female sex was associated with 16% lower odds of in-hospital mortality (OR 0.841, p < 0.001) after adjusting for age, NYHA stage, and comorbidities, despite women showing higher unadjusted mortality (8.34% vs 7.90%) in 2,616,462 LVHF hospitalizations in Germany.

Q: What question did this study set out to answer?

The study aims to examine how disease severity and outcomes of left ventricular heart failure differ between sexes.

Key Result

Female sex was associated with 16% lower odds of in-hospital mortality (OR 0.841, p < 0.001) after adjusting for age, NYHA stage, and comorbidities, despite women showing higher unadjusted mortality (8.34% vs 7.90%) in 2,616,462 LVHF hospitalizations in Germany.

Key Points

The study aims to examine how disease severity and outcomes of left ventricular heart failure differ between sexes.
Analyzed a nationwide cohort of patients with left ventricular heart failure.
Evaluated outcomes by sex in relation to NYHA stage.
Assessed overall mortality and subgroup outcomes for men and women.
Overall mortality was higher in women with LVHF.
Men experienced worse outcomes in most assessed subgroups.
Findings highlight the need for tailored LVHF management based on sex and stage.

Study Design

Type

Cohort (n=2,616,462)

Multicenter

Yes

Structured PICO

Population

2,616,462 inpatient hospitalization cases of patients with the primary diagnosis of left ventricular heart failure (LVHF) in Germany between 2014 and 2022, with balanced sex distribution (50.29% male, 49.71% female).

Outcome

In-hospital mortality, median healthcare costs, and length of hospitalizationhard clinical

Although women with LVHF have higher unadjusted in-hospital mortality, multivariable adjustment reveals female sex is associated with lower mortality risk, highlighting the critical impact of age, comorbidities, and NYHA stage on outcomes.

Main Result

Effect estimate: OR 0.841 for female sex (95% CI [0.833; 0.849])

Absolute Event Rate: 8.34% vs 7.9%

p-value: p=<0.001

Limitations

LVEF data not available, limiting HF phenotype stratification
No data on pharmacological treatment or outpatient prescriptions
Lack of laboratory values including natriuretic peptides
NYHA classification reflects functional status at admission, not stable baseline
Observational study with only associative findings, no causal inference
Potential coding inaccuracies and changes over time
Data specific to Germany, limiting generalizability
Hospitalization data case-based rather than patient-based
No outpatient or post-discharge outcome data
No data on quality of life or readmission rates
Possible residual confounding by unmeasured factors
Underrepresentation of women in trials, limiting understanding of treatment effects

Abstract

LVHF outcomes and costs differ by sex and NYHA stage. Though women had higher overall mortality, men showed worse outcomes in most subgroups. These findings stress the importance of sex- and stage-specific LVHF management strategies.

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