4 be single, widowed or divorced, living alone, and earning less annual income (P < .01). At baseline, men were more likely to have a LVEF ≤ 40% (P < .01). There were no sex diﬀerences in both the major and minor criteria for heart failure (Table 2(b)). The number of comorbid conditions were not signiﬁcantly diﬀerent between genders but were ranked diﬀerently with women reporting higher prevalence of asthma, angina, visual impairment, and depression and men reporting degenerative disc disease, myocardial infarc- tion, diabetes, lung disease, and hearing impairment. 5.1. Gender Diﬀerences in Social Support. Table 3 presents the mean subscale and overall social support scores at baseline. Mean (SD) scores for females ranged from 67.3 (31.7) to 80.9 (27.0), with aﬀectionate support being the highest subscale score. Mean (SD) scores for males ranged from 72.3 (32.9) to 80.4 (30.4), with tangible and aﬀectionate support being the highest subscale scores. Women tended to report lower scores overall, but only tangible support was signiﬁcantly lower (P < .01). 5.2. Functional Outcomes. Table 4 presents the KCCQ-PL and SF-12-PCS scores and the 5-level categorized variables (i.e., improved, declined, etc.), by gender. Women, in comparison to men, reported signiﬁcantly lower mean PL scores (±SD) at baseline (28.7 ± 7.6 versus 30.8 ± 8.6; P = .01) and 12 months (30.3 ± 7.5 versus 34.2 ± 10.4; P < .01). Similarly, women reported signiﬁcantly lower mean PCS scores (±SD) than men at baseline (45.4 ± 24.2 versus 52.1 ± 26.8; P = .01) and 12 months (51.0 ± 24.4 versus 61.5 ± 27.9; P < .01). There were no signiﬁcant gender diﬀerences in the 5-level outcome variables for disease-speciﬁc and generic health outcomes at 12 months. Across the 12-month period, maintenance or improvement of functioning, as measured with either the PCS or PL, occurred in approximately 1/3 of the sample. 5.3. Social Support and Adverse Functional Outcomes. Tables 5 and 6 assess if social support predicts decline in functional outcomes after adjusting for age and sex. Overall, none of the social support domains was signiﬁcantly associated with a decline in the SF-12-PCS; however, increasing levels of informational support, social and overall support were weakly and signiﬁcantly associated with less decline in KCCQ-PL changes. Several sex-speciﬁc associations were identiﬁed. Men were less likely to experience disease-related functional decline with higher levels of aﬀection support (OR .75, 95% CI .59, .96). When using the generic PCS functional outcome score as the dependent variable, levels of emotional/informational support (OR .70; 95% CI: .52, .93), aﬀectionate support (OR .76; 95% CI: .59, .98), and positive social interaction (OR .78; 95% CI: .61, 1.00) in men were signiﬁcantly associated with functional decline. There was an eﬀect modiﬁcation of gender on social support; males with high social support scores were less likely to report a functional adverse outcome, when using the PCS score as the basis for functional decline. Sensitivity analysis, in which participants lost to followup were grouped with the functional declining group, resulted Cardiology Research and Practice in similar ﬁndings to the aforementioned logistic regression models. Male participants were less likely to experience functional decline with more support; this was not the case for women. 6. Discussion The purpose of this study was to describe the independent and combined eﬀects of gender and social support on one- year functional status in older persons with HF. Women consistently reported lower levels of functioning, but over the course of the year, following an exacerbation of their illness, both women and men experienced similar levels of functional maintenance or decline. The eﬀect of social support on maintenance of function was limited to men, where men who perceived high levels of support experienced better outcomes. The personal, social, and clinical characteristics of par- ticipants in this cohort study were similar to those of both older persons in general and to those with HF. Women, in comparison to men, were more likely to be single and on their own, with less income. A portrait of Seniors in Canada prepared by Health Canada in 2002 reported that nearly 75% of Canadian senior men compared to 41% of Canadian senior women were married, and 46% of senior women were widowed compared to 13% of senior men. Our study grouped single and divorced individuals with those who were widowed, unlike Health Canada that compared only widowed to those who were married. This diﬀerence in grouping is likely the reason for the comparatively higher percentage of participants in our nonmarried group and is of particular relevance to this study as we were exploring the availability of support regardless of reason. Also, as expected, men were more likely to have lower left ventricular ejection fraction. Generally men, regardless of age, are more likely than women to develop systolic dysfunction and typically have lower LVEF, more severe disease, and shorter survival times [25, 26] and, consequently, may require intense and shorter duration of support to optimize their functioning within the context of their progressive disease. However, since survival times are lengthier for women, they are living longer with HF than men and, therefore, may require more long-term support. 6.1. Gender and Functional Status. Similar to other studies, our ﬁndings show that, compared to male participants, female participants reported signiﬁcantly lower physical functioning, as measured by both disease-speciﬁc and generic measures and all participants reported low levels of functioning with only about one third of the sample maintaining or improving their functional level over the course of the year. In a cross-sectional, correlation study, Heo and colleagues [27] used the Duke Activity Status Index, a self-report tool, to assess the functional status of 122 HF patients. Out of a possible score ranging from 0 to 58, women reported lower functional status scores than men; mean scores (±SD) were 10.2 (±10.3) and 14.5 (±12.7), respectively (P = .04) [19]. Riedinger et al. [28] also demonstrated comparable results in a cross-sectional