Women Hospitalized With COVID-19 at Higher Risk for AHF Than Men

In patients hospitalized for COVID-19, compared with men, women have a higher risk for acute heart failure and in-hospital mortality.

In general wards, women are at increased risk for acute heart failure (AHF) and in-hospital mortality from COVID-19 compared with men, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Differences in mortality from COVID-19 have been observed between men and women. However, to date, little is known about differences in organ-specific dysfunction between genders.

In this study, investigators from the University of Bologna in Italy retrospectively evaluated patient data collected between March 2020 and February 2022 at 17 hospitals in 5 European countries that were participating in the International Survey of Acute Coronavirus Syndrome (ISACS; ClinicalTrials.gov Identifier: NCT05188612). The outcomes of interest were acute respiratory failure, AHF, acute kidney injury (AKI), and in-hospital mortality.

A total of 4499 patients were hospitalized with COVID-19, among whom 33.9% were admitted to the ICU and 24.8% died in-hospital.

Among all patients, a significant interaction was observed (P =.04), in which women (adjusted risk ratio [aRR], 1.13; 95% CI, 0.90-1.42) were at higher risk for in-hospital mortality than men (aRR, 0.86-0.70-1.05).

Equitable access to COVID-19 ICU care is needed to minimize the unfavorable outcome of women presenting with COVID-19 related complications.

In-hospital mortality was associated with developing acute respiratory failure (odds ratio [OR], 3.95; 95% CI, 3.04-5.14), AKI (OR, 3.85; 95% CI, 3.21-4.63), and AHF (OR, 2.27; 95% CI, 1.73-2.98).

Men and women were at similar risk for developing AKI and acute respiratory failure, regardless of ward placement. In contrast, women were at higher risk for AHF (RR, 1.25; 95% CI, 0.94-1.67) compared with men (RR, 0.83; 95% CI, 0.59-1.16) in general wards (Pinteraction =.04) but not in the ICU.

Women were less likely to be admitted to the ICU than men (RR, 0.80; 95% CI, 0.71-0.91).

 “Women in general wards were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF, and mortality appeared to be independent of sex,” the study authors wrote. “Equitable access to COVID-19 ICU care is needed to minimize the unfavorable outcome of women presenting with COVID-19 related complications.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Cenko E, Bergami M, Zdravkovic M, et al. Sex differences and disparities in cardiovascular complications and intensive care unit admission associated with COVID-19. Abstract presented at: ACC 2023; March 4-6, 2023; New Orleans, LA. 1068-009.