[Heart failure phenotype in women]

Area of Science:

• Cardiology and Cardiovascular Diseases
• Sex and Gender in Medicine
• Internal Medicine

Context:

• Heart failure (HF) affects approximately 50% of women, yet their clinical presentation and outcomes differ significantly from men.
• International evidence and Italian regional data highlight these gender-specific disparities in HF.
• Existing treatment guidelines are primarily based on studies conducted in predominantly male populations with systolic dysfunction.

Purpose:

• To delineate the distinct clinical phenotype of heart failure in women compared to men.
• To identify underlying sex-based differences in cardiac structure and function contributing to HF presentation.
• To underscore the need for sex-specific therapeutic strategies in heart failure management.

Summary:

• Women with HF typically develop the condition later in life, often with preserved systolic function and less frequently due to ischemic heart disease.
• Despite generally better survival rates, women experience greater symptomatic burden, reduced quality of life, and longer hospital stays during acute HF admissions.
• Pathophysiological differences include a propensity for concentric remodeling, characterized by thicker walls, smaller volumes, and increased chamber stiffness in the female heart.

Impact:

• Highlights the critical need to re-evaluate current heart failure treatment paradigms, which may not adequately address the unique characteristics of the female HF population.
• Emphasizes that therapeutic strategies derived from male-dominated studies may be suboptimal for women, necessitating further research.
• Calls for future clinical trials to explore and validate tailored treatment approaches for the predominantly elderly female heart failure demographic.