Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec;18(6):345-352.
doi: 10.1007/s11897-021-00533-y. Epub 2021 Nov 15.

Heart Failure with Reduced Ejection Fraction-Does Sex Matter?

Sascha Swaraj  1 , Rebecca Kozor  1   2 , Clare Arnott  3 , Belinda A Di Bartolo  1 , Gemma A Figtree  4   5
Affiliations
Review

Heart Failure with Reduced Ejection Fraction-Does Sex Matter?

Sascha Swaraj et al. Curr Heart Fail Rep. 2021 Dec.

Abstract

Purpose of review: There is an increasing recognition of the importance of sex in susceptibility, clinical presentation, and outcomes for heart failure. This review focusses on heart failure with reduced ejection fraction (HFrEF), unravelling differences in biology, clinical and demographic features and evidence for diagnostic and therapeutic strategies. This is intended to inform clinicians and researchers regarding state-of-the-art evidence relevant to women, as well as areas of unmet need.

Recent findings: Females are well recognised to be under-represented in clinical trials, but there have been some improvements in recent years. Data from the last 5 years reaffirms that women presenting with HFrEF women are older and have more comorbidities like hypertension, diabetes and obesity compared with men and are less likely to have ischaemic heart disease. Non-ischaemic aetiologies are more likely to be the cause of HFrEF in women, and women are more often symptomatic. Whilst mortality is less than in their male counterparts, HFrEF is associated with a bigger impact on quality of life in females. The implications of this for improved prevention, treatment and outcomes are discussed. This review reveals distinct sex differences in HFrEF pathophysiology, types of presentation, morbidity and mortality. In light of this, in order for future research and clinical medicine to be able to manage HFrEF adequately, there must be more representation of women in clinical trials as well as collaboration for the development of sex-specific management guidelines. Future research might also elucidate the biochemical foundation of the sex discrepancy in HFrEF.

Keywords: Female; Gender; Heart failure; Male; Reduced ejection fraction; Sex.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Heart failure with reduced ejection fraction—does sex matter? The impact of sex in HFrEF can be demonstrated through the mechanisms and demographics, presenting features and outcomes. Where men are more likely to develop HFrEF from ischaemic heart disease (IHD), present with lower ejection fractions and have a higher mortality, women tend to have non-ischaemic cardiomyopathy or valvular aetiology of HFrEF, be older at presentation, are more likely to have comorbidities like hypertension and chronic kidney disease, and experience more symptoms and report a poorer quality of life. QOL, quality of life; LOS, length of stay; HFrecEF, heart failure with recovered ejection fraction; IHD, ischaemic heart disease; LVEF, left ventricular ejection fraction
See this image and copyright information in PMC

References

    1. Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J 2020;5.
    1. Kenchaiah S, Vasan R. Heart failure in women—insights from the Framingham Heart Study. Cardiovasc Drugs Ther. 2015;29:377–390. doi: 10.1007/s10557-015-6599-0. - DOI - PMC - PubMed
    1. Hsich EM, Grau-Sepulveda M, Hernandez AF, Eapen ZJ, Xian Y, Schwamm LH, et al. Relationship between sex, ejection fraction, and B-type natriuretic peptide levels in patients hospitalized with heart failure and associations with inhospital outcomes: findings from the Get With The Guideline-Heart Failure Registry. Am Heart J. 2013;166(6):1063–1071. doi: 10.1016/j.ahj.2013.08.029. - DOI - PubMed
    1. Badran HM, Elgharably M, Faheem N. Clinical characteristics and in-hospital outcomes of heart failure in women: a single center registry from Egyptian cardiac care unit. . Egypt Heart J. 2019;71(1):doi.org/10.1186/s43044-019-0032-0. - PMC - PubMed
    1. Kocabas U, Kivrak T, Oztekin GMY, Tanik VO, Ozdemir I, Kaya E, et al. Gender related clinical and management differences in patients with chronic heart failure with reduced ejection fraction. . Int J Clin Pract. 2020;75(3):doi.org/10.1111/ijcp.13765. . - PubMed