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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Sex-Related Differences in Heart Failure With Preserved Ejection Fraction
Pooja Dewan1, Rasmus Rørth1,2, Valeria Raparelli3,4
1BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.D., R.R., R.T.C., L.S., P.S.J., M.C.P., J.J.V.M.).
Insights
Women with heart failure with preserved ejection fraction experience worse symptoms but have better survival rates and half the risk of sudden cardiac death compared to men. These findings highlight key sex-based differences in heart failure outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Sex Differences in Health
Background:
- Heart failure with preserved ejection fraction (HFpEF) affects millions globally.
- Understanding sex-based differences in HFpEF is crucial for targeted treatment strategies.
Purpose of the Study:
- To delineate the distinct characteristics and clinical outcomes between women and men diagnosed with HFpEF.
- To compare the incidence of primary composite outcomes, cardiovascular death, and heart failure hospitalizations in male and female HFpEF patients.
Main Methods:
- Analysis of pooled data from 8468 patients (4458 women, 4010 men) across three major clinical trials: CHARM-Preserved, I-Preserve, and TOPCAT-Americas.
- Comparison of baseline demographics, biomarkers, quality of life metrics, and major adverse cardiovascular events between sexes.
- Statistical analysis using hazard ratios to assess outcome disparities.
Main Results:
- Women were older, more likely to be obese and hypertensive, but less likely to have coronary artery disease or atrial fibrillation compared to men.
- Women reported more congestion symptoms and poorer quality of life.
- Despite these factors, women exhibited a lower risk of the primary composite outcome (HR 0.80) and cardiovascular death (HR 0.70), driven by a significantly lower risk of sudden death (HR 0.53).
Conclusions:
- Significant sex-based disparities exist in HFpEF patient profiles and outcomes.
- Women with HFpEF face greater symptomatic burden and poorer quality of life but achieve better survival, particularly due to reduced sudden cardiac death risk.
- These findings underscore the need for sex-specific considerations in managing HFpEF.
Background:
To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction.
Methods:
Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial).
Results:
Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73-0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62-0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82-1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43-0.65]; P<0.001). E/A ratio was lower in women (1.1 versus 1.2).
Conclusions:
There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255.
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