Heart Failure with Reduced Ejection Fraction in Women: Epidemiology, Outcomes, and Treatment

Abstract

There are millions of people affected by heart failure with reduced ejection fraction (HFrEF) as diagnosed with ejection fraction 40% or less by imaging. Established therapies have been proven through clinical trials on lifestyle interventions, medications, and devices for HFrEF to improve quality of life, heart function, and survival. Although there are more men than women suffering with HFrEF, there are no prospectively proven, sex-specific guideline therapies because women have been underrepresented in clinical trials. Current recommendations for medications in women with HFrEF are described in this article.

Keywords: Cardiomyopathies; Sex differences; Systolic heart failure; Women.

Fig. 1.

Sex differences in incidence of heart failure with reduced EF (HFrEF) and heart failure with preserved EF (HFpEF). Data regarding the incidence of age-adjusted heart failure in Olmsted County, Minnesota, between January 1, 2000, and December 31, 2010, were stratified by sex and EF. The incidence of heart failure declined for both women and men but was greater in women with HFrEF compared with men with HFrEF or HFpEF. (From Gerber Y, Weston SA, Redfield MM, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med 2015;175(6):996–1004; with permission.)

Fig. 2.

Sex differences in left ventricular EF (LVEF) among subjects from the Framingham Heart Study who developed heart failure (N = 73). (From Vasan RS, Larson MG, Benjamin EJ, et al. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 999;33(7):1948–50; with permission.)

Fig. 3.

Sex differences in outcome among HFrEF subjects in PARADIGM-HF taking sacubitril-valsartan (LCZ696) versus control therapy (enalapril). The combined primary endpoint was mortality and heart failure hospitalization. (Adapted from McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014;371(11):993–1004; with permission.)

Fig. 4.

Sex differences in HR for heart failure hospitalization among subjects with and without CardioMEMS. (From Loh JP, Barbash IM, Waksman R. Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the CardioMEMS Champion Heart Failure Monitoring System. J Am Coll Cardiol 2013;61(15):1571–5; with permission.)