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Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction
Jesse F Veenis1, Hans-Peter Brunner-La Rocca2, Gerard C M Linssen3
1Department of Cardiology, University Medical Center Rotterdam, the Netherlands.
Insights
Women with heart failure with reduced ejection fraction receive different medication doses than men. A hypothetical sex-specific dosing strategy could improve treatment adequacy for women, though some may still be overdosed.
Area of Science:
- Cardiology
- Pharmacology
- Sex and Gender in Medicine
Background:
- Heart failure with reduced ejection fraction (HFrEF) treatment often involves renin-angiotensin-system inhibitors and beta-blockers.
- Previous studies suggest potential sex-based differences in optimal medication dosing for HFrEF.
Purpose of the Study:
- To assess current medical treatment of HFrEF in men and women.
- To evaluate the hypothetical impact of sex-specific dosing on treatment adequacy and potential over-dosing in women.
Main Methods:
- Analysis of a large contemporary heart failure registry including 5320 men and 3003 women with HFrEF.
- Detailed collection of heart failure therapy prescription and dosage information.
Main Results:
- Women received renin-angiotensin-system inhibitors less often (79% vs 83%) but beta-blockers more often (82% vs 79%) than men.
- A hypothetical sex-specific dosing schedule significantly increased adequate treatment levels for women (beta-blocker 87% vs 54%, renin-angiotensin-system inhibitor 96% vs 75%).
- A notable percentage of women could be relatively overdosed under the new schedule (24% for beta-blockers, 52% for renin-angiotensin-system inhibitors).
Conclusions:
- Significant, though small, sex-based differences in HFrEF medication dosing exist.
- Implementing sex-specific dosing could improve adequate treatment for more women.
- A subset of women may be at risk of over-dosing and potential side-effects.
Aims:
A recent study suggested that women with heart failure and heart failure reduced ejection fraction might hypothetically need lower doses of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers ( = renin-angiotensin-system inhibitors) and β-blockers than men to achieve the best outcome. We assessed the current medical treatment of heart failure reduced ejection fraction in men and women in a large contemporary cohort and address the hypothetical impact of changing treatment levels in women.
Methods:
This analysis is part of a large contemporary quality of heart failure care project which includes 5320 (64%) men and 3003 (36%) women with heart failure reduced ejection fraction. Detailed information on heart failure therapy prescription and dosage were collected.
Results:
Women less often received renin-angiotensin-system inhibitors (79% vs 83%, p < 0.01), but more often β-blockers (82% vs 79%, p < 0.01) than men. Differences in guideline-recommended target doses between sexes were relatively small. Implementing a hypothetical sex-specific dosing schedule (at 50% of the current recommended dose in the European Society of Cardiology guidelines in women only) would lead to significantly higher levels of women receiving appropriate dosing (β-blocker 87% vs 54%, p < 0.01; renin-angiotensin-system inhibitor 96% vs 75%, p < 0.01). Most interestingly, the total number of women with >100% of the new hypothetical target dose would be 24% for β-blockers and 52% for renin-angiotensin-system inhibitors, which can be considered as relatively overdosed.
Conclusion:
In this large contemporary heart failure registry, there were significant but relatively small differences in drug dose between men and women with heart failure reduced ejection fraction. Implementation of the hypothetical sex-specific target dosing schedule would lead to considerably more women adequately treated. In contrast, we identified a group of women who might have been relatively overdosed with increased risk of side-effects and intolerance.
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