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Jan 08, 2020

Women with Heart Failure Face Greater Risk of Death After Surgery than Men

Women tend to fare better after surgery, except in study patients with heart failure. 

While women tend to have better outcomes after surgery compared to men, the same can’t be said for female patients with heart failure, based on a recent study of U.S. veterans. The analysis included data from nearly 50,000 patients with heart failure and found that women have the same, if not greater, risk of mortality after surgery than men.

Published in JAMA: Network Open, this study compared three-month survival among men and women with heart failure after surgery. The goal was to see whether women—who generally have a longer lifespan and lower risk of death—fare better than men after operations.

Heart failure is a chronic disease that occurs when the heart can’t pump enough blood to the rest of the body. It affects an estimated 5.7 million U.S. adults and increases risk for health complications—including complications after surgery.

Using a registry of patients from the Veterans Affairs health care system, this study identified nearly 610,000 patients that underwent noncardiac surgery between 2006 and 2016. Among participants, 47,997 had heart failure and 3% were women.

Not surprisingly, when comparing survival rates three months after surgery, researchers found that patients with heart failure had significantly greater risk of death than surgical patients without heart failure. However, women with heart failure did not have better outcomes than men, as experts expected.

Among patients with heart failure, risk of death after surgery was no different among men and women. When compared to all surgical patients, women had nearly 2.5 times greater risk of death after surgery, while heart failure only increased mortality risk among men by 64%.

What findings suggest, according to authors, is that heart failure is an equalizer for survival among surgical patients.

Studies have shown that women have a higher life expectancy and improved survival in the face of challenges like trauma and famine than men do. Women also have better outcomes after hospitalizations and surgery, suggesting that sex can have a protective effect on health.

Based on study findings, however, heart failure may level the playing field. Not only does heart failure increase risk of death after surgery in all patients, surgery may carry even greater risk of death in women with heart failure than men.

Authors explain that based on study design, their findings can’t prove cause and effect. They also note that there was a small proportion of women and all were U.S. veterans, limiting generalization to the rest of the population.

Questions for You to Consider

  • What is heart failure?

  • Heart failure occurs when the heart is unable to pump enough blood to the rest of the body. Although there is no cure for heart failure, treatments such as ACE inhibitors and ARBs can help improve outcomes as well as quality of life.
  • How is heart failure treated?

  • Although treatments for heart failure rarely reverse or stop the progression of the disease, various therapies can help slow the progression of heart failure, such as medications, surgeries and medical devices. Which therapies are best depends on each individual patient.

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