{
  "abstract": "Background Multiple long-term conditions (MLTCs) are common among individuals with heart failure (HF); however, the influence of sex on clinical characteristics and prognosis remains unclear. This study investigated sex-related differences in clinical characteristics and prognosis in individuals with HF and a high MLTC burden.Methods We conducted a multicentre retrospective study of 3004 hospitalised patients with HF who survived to discharge. Comorbid chronic conditions were defined using the Charlson Comorbidity Index (CCI), and MLTC burden was quantified using the age-adjusted CCI. Patients were stratified into high (CCI≥6; n=1514) and low (CCI<6; n=1490) MLTC burden groups based on the median age-adjusted CCI, and comparisons were made by sex. The primary outcome was a composite of all-cause death or HF readmission within 1 year.Results The prevalence of ≥2 comorbid conditions increased with age, peaking before age 85 and declining slightly thereafter. This trend differed by sex, with a steeper age-related increase observed in men. In the high MLTC burden group, females were older, had higher left ventricular ejection fraction and were prescribed fewer medications than men. Dementia and rheumatologic disease were more common in women. Although no significant sex differences in event-free survival were observed overall in either MLTC group, among individuals aged≥75 years with high MLTC burden, men had a significantly higher risk of adverse events than women (HR: 1.334; 95% CI 1.031 to 1.727). A spline-based three-way interaction analysis (age×sex×MLTC burden) demonstrated that male risk exceeded female risk after age 70, only in the high MLTC burden group.Conclusion In individuals with HF and a high MLTC burden, age-dependent sex differences in prognosis were evident. These findings highlight the importance of incorporating age-specific and sex-specific approaches into personalised HF care.Trial registration number UMIN000054854.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan"
      ],
      "name": "Shuhei Tara"
    },
    {
      "affiliations": [
        "Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan"
      ],
      "name": "Yayoi Tetsuou Tsukada"
    },
    {
      "affiliations": [
        "Department of Health Policy and Management, Nippon Medical School, Tokyo, Japan"
      ],
      "name": "Takuya Nishino"
    },
    {
      "affiliations": [
        "Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan"
      ],
      "name": "Katsuhito Kato"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan"
      ],
      "name": "Takeshi Yamamoto"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan"
      ],
      "name": "Mitsunori Maruyama"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan"
      ],
      "name": "Eitaro Kodani"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan"
      ],
      "name": "Nobuaki Kobayashi"
    },
    {
      "affiliations": [
        "Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan"
      ],
      "name": "Akihiro Shirakabe"
    },
    {
      "affiliations": [
        "Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan"
      ],
      "name": "Kuniya Asai"
    }
  ],
  "title": "Sex differences in the burden of multiple long-term conditions among Japanese individuals with heart failure",
  "uid": "1ddeb101-ea65-5583-bc55-1c55b2c07786"
}