Heart Failure with Reduced Ejection Fraction-Does Sex Matter?

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.

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