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J Am Coll Cardiol. 2019 Jan 8;73(1):29-40. doi: 10.1016/j.jacc.2018.09.081.

Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women.

Author information

1
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
2
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
3
Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
4
Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio.
5
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
6
Department of Cardiology, Stavanger University Hospital, University of Bergen, Stavanger, Norway.
7
Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
8
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
9
Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Quebec, Canada.
10
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
11
Division of Cardiology, Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina.
12
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom. Electronic address: john.mcmurray@glasgow.ac.uk.

Abstract

BACKGROUND:

Heart failure (HF) trials initiated in the last century highlighted many differences between men and women. Of particular concern was undertreatment of women compared with men, but much has changed during the past 20 years.

OBJECTIVES:

This study sought to identify these changes, which may give a new perspective on the management of, and outcomes in, women with HF.

METHODS:

The study analyzed 12,058 men and 3,357 women enrolled in 2 large HF with reduced ejection fraction (HFrEF) trials with near identical inclusion and exclusion criteria and the same principal outcomes. Outcomes were adjusted for other prognostic variables including N-terminal pro-B-type natriuretic peptide.

RESULTS:

Women were older and more often obese than men were, had slightly higher systolic blood pressure and heart rate, and were less likely to have most comorbidities, except hypertension. Women had more symptoms and signs (e.g., pedal edema 23.4% vs 19.9%; p < 0.0001) and worse quality of life-median Kansas City Cardiomyopathy Questionnaire Clinical Summary Score 71.3 (interquartile range: 53.4 to 86.5) versus 81.3 (interquartile range: 65.1 to 92.7; p < 0.0001)-despite similar left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide. However, women had lower mortality (adjusted hazard ratio: 0.68; 95% confidence interval: 0.62 to 0.74; p < 0.001) and risk of HF hospitalization (hazard ratio: 0.80; 95% confidence interval: 0.72 to 0.89; p < 0.001). Diuretics and anticoagulants were underutilized in women. Device therapy was underused in both men and women, but more so in women (e.g., defibrillator 8.6% vs. 16.6%; p < 0.0001).

CONCLUSIONS:

Although women with HFrEF live longer than men, their additional years of life are of poorer quality, with greater self-reported psychological and physical disability. The explanation for this different sex-related experience of HFrEF is unknown as is whether physicians recognize it. Women continue to receive suboptimal treatment, compared with men, with no obvious explanation for this shortfall.

KEYWORDS:

heart failure; sex; women

PMID:
30621948
DOI:
10.1016/j.jacc.2018.09.081
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