Females and Exercise Capacity Impairment in Heart Failure: A Sex-Focused Analysis

Area of Science:

• Cardiology
• Gerontology
• Exercise Physiology

Background:

• Heart failure (HF) is increasingly prevalent, particularly in older females, with notable sex-based differences in its progression, treatment, and prognosis.
• Submaximal exercise capacity (SEC), commonly assessed by the six-minute walk test (6MWT), is a crucial indicator of aerobic function, prognosis, and quality of life in HF patients.
• Existing research on sex differences in SEC within HF populations is limited and yields inconsistent findings.

Purpose of the Study:

• To investigate the independent association between sex and submaximal exercise capacity (SEC) in patients with chronic heart failure (HF).
• To identify clinical and psychosocial factors associated with reduced SEC in HF.
• To emphasize the need for sex-specific approaches in managing HF.

Main Methods:

• A single-centre, prospective cohort study involving 1069 patients with chronic HF, recruited between 2004 and 2014.
• SEC was evaluated using the six-minute walk test (6MWT).
• Multivariate models were employed to analyze the relationship between sex and SEC, controlling for various clinical and psychosocial variables.

Main Results:

• Females exhibited significantly shorter 6MWT distances (155 ± 149 m) compared to males (265 ± 164 m; p < 0.001).
• Female sex was identified as an independent predictor of impaired SEC across unadjusted and adjusted analyses (ORs 2.226–3.609; p < 0.001).
• Other factors linked to reduced SEC included older age, higher NYHA class, elevated heart rate, diabetes, iron deficiency, functional dependence, cognitive impairment, and depressive symptoms.

Conclusions:

• Female sex is a significant, independent predictor of diminished functional capacity in individuals with chronic HF.
• These findings underscore the necessity of developing sex-specific strategies that incorporate both clinical and psychosocial elements to enhance HF patient outcomes.
• Further research into sex-specific pathophysiological mechanisms and tailored interventions is warranted.