Women, men and heart failure: a review

Area of Science:

• Cardiology
• Geriatrics
• Gender Medicine

Background:

• Chronic heart failure (HF) is a leading cause of morbidity and mortality, particularly in individuals over 65.
• Recent advances in HF diagnosis and treatment have improved outcomes, but benefits are less pronounced for women and the elderly.
• Significant sex-based differences exist in HF presentation, including age, hypertension prevalence, coronary heart disease (CHD) evidence, and ventricular function.

Purpose of the Study:

• To examine the sex-based differences in heart failure (HF) presentation, treatment response, and outcomes.
• To highlight the need for further research into HF with preserved systolic function, which is more common in women.
• To advocate for the incorporation of gender-specific considerations into future European guidelines for HF management.

Main Methods:

• Review of existing literature and intervention studies focusing on heart failure (HF) in men and women.
• Analysis of sex differences in HF etiology, clinical presentation, and response to evidence-based treatments.
• Comparison of survival rates and quality of care between men and women with HF.

Main Results:

• Women with HF tend to be older, more hypertensive, and less likely to have CHD, often presenting with preserved ventricular function.
• Hypertension is a more significant factor in HF development in women than in men.
• Despite similar lifetime risks, men have a higher incidence of HF. Women with HF generally have better survival rates, potentially due to better systolic function or less CHD, though overall HF mortality remains high.
• Evidence-based treatments for reduced ventricular function show similar benefits for both sexes; however, trials predominantly include men.

Conclusions:

• Sex differences in HF necessitate tailored research and clinical approaches, particularly for HF with preserved systolic function.
• Current guidelines do not adequately differentiate between sexes, despite observed differences in HF presentation and outcomes.
• Future research should focus on improving prognosis for patients with HF and preserved systolic function, and European guidelines should integrate gender-specific issues.