Sex-Specific Differences in In-Hospital Outcomes and Costs in Chronic Left Ventricular Heart Failure: Insights from Over 2.6 million Hospitalizations in a Nationwide German Cohort

Aims: Chronic left ventricular heart failure (CLHF) is a leading cause of morbidity and mortality worldwide. Sex-specific differences in clinical presentation and outcomes are increasingly recognized. This study investigates the interplay between sex, New York Heart Association (NYHA) classification, and in-hospital outcomes.

Methods: We analyzed data from 2,616,462 hospitalizations with a primary diagnosis of CLHF (ICD-10-GM I50.11–I50.14) in Germany between 2014 and 2022 using the DESTATIS national hospital dataset. Patients were stratified by sex and NYHA class. Baseline characteristics, cardiovascular risk factors, comorbidities, procedures, complications, and in-hospital outcomes were assessed.

Results: Women were more frequently classified in earlier NYHA stages (e.g., NYHA I: 55.95% female), while men predominated in NYHA III. In-hospital mortality was slightly higher among women (8.34% vs. 7.90%; Table 1). However, age- and NYHA-stratified analyses revealed higher mortality in men across most subgroups, except for selected age groups in NYHA I, III, and IV (Figure 1). Our data showed that male patients were younger, had shorter or comparable hospital stays, and more frequently underwent invasive procedures and experienced complications.

Conclusion: In a nationwide cohort, CLHF patients exhibited marked sex-specific differences in presentation and outcomes. While crude mortality was higher in women, men had poorer outcomes across most NYHA and age subgroups, emphasizing the need for tailored management strategies.