[Gender differences in non-pharmacological treatment of chronic heart failure]

Prior studies demonstrated sex-related differences in many aspects of chronic heart failure (HF), and in the appropriate use, individual response or complication rates with non-pharmacological treatment, too. There is seasonal variability in morbidity and mortality of HF with significant gender differences, partially due to respiratory diseases, which may be potentionally preventable by vaccination. Quitting smoking is associated with substantial decrease in morbidity and mortality in HF patients which is similar in magnitude to the effect of an appropriate beta-blocker use. Yet little emphasis has been placed on smoking cessation strategies in women with HF and should be adopted as vigorously as proven medical therapy. Complications of catheter ablation for atrial fibrillation were more frequent in females. Gender disparity exists in the use of implantable cardioverter-defibrillators and cardiac resynchronization therapy, although they are beneficial for both women and men. Smaller women have limited access to left ventricular assist device (LVAD) because these devices require a minimum body surface to fit properly. Women were more likely than men to develop severe right ventricular failure after implantation of LVAD. Lower cut-off level of peak oxygen consumption was suggested for women to determine optimal timing for heart transplantation. Disease management programs probably narrows gender differences in quality of care and survival among HF patients. Women with HF have less access to cardiologists, although this consultation is associated with better quality of care, particularly for women. Despite these known sex differences, recommendations for HF are the same for women and men, because prospective sex-specific clinical trials have not been performed.