Affiliation:
1. Division of Cardiology HCM Institute Tufts Medical Center Boston MA
2. Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
Abstract
Background
The relation of sex to clinical presentation and course in hypertrophic cardiomyopathy (
HCM
) remains incompletely resolved. We assessed differences in clinical outcomes between men and women within our large
HCM
cohort.
Methods and Results
Of 2123 consecutive patients, a minority (38%) were women who were diagnosed with
HCM
at older ages or referred for subspecialty evaluation later than men (50±19 versus 44±16 and 55±18 versus 49±16;
P
<0.001). Women more commonly developed advanced New York Heart Association class
III
/
IV
symptoms (53% versus 35% in men;
P
<0.001), predominantly secondary to outflow obstruction. While end‐stage heart failure with systolic dysfunction (ejection fraction <50%) was similar in men (5% versus 4% in women;
P
=0.33), women were 3‐fold more likely to develop heart failure with preserved systolic function (7.5% versus 2.6%;
P
=0.002). Sudden death events terminated by defibrillator therapy were similar in women (0.9%/year) versus men (1.0%/year; hazard ratio, 0.92; 95%
CI
, 0.6–1.5;
P
=0.73).
HCM
mortality was uncommon, with identical rates in both sexes (0.3%/year; hazard ratio, 1.5; 95%
CI
, 0.7–3.4;,
P
=0.25). Age‐adjusted all‐cause mortality also did not differ between women and men (1.7% versus 1.3%/year; hazard ratio, 1.32; 95%
CI
, 0.92–1.91;
P
=0.13).
Conclusions
Survival was not less favorable in women with
HCM
. Contemporary treatments including surgical myectomy to reverse heart failure and defibrillators to prevent sudden death, were effective in both sexes contributing to low mortality. However, despite more frequent outflow obstruction, women with
HCM
are underrecognized and referred to centers later than men, often with more advanced heart failure. Greater awareness of
HCM
in women should lead to earlier diagnosis and treatment, with implications for improved quality of life.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
61 articles.
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