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Review
. 2022 Jul 11:9:890108.
doi: 10.3389/fcvm.2022.890108. eCollection 2022.

Special Considerations in the Care of Women With Advanced Heart Failure

Imo A Ebong  1 , Ersilia M DeFilippis  2 , Eman A Hamad  3 , Eileen M Hsich  4   5 , Varinder K Randhawa  5 , Filio Billia  6 , Mahwash Kassi  7 , Anju Bhardwaj  8 , Mirnela Byku  9 , Mrudala R Munagala  10 , Roopa A Rao  11 , Amy E Hackmann  12 , Claudia G Gidea  13 , Teresa DeMarco  14 , Shelley A Hall  15
Affiliations
Review

Special Considerations in the Care of Women With Advanced Heart Failure

Imo A Ebong et al. Front Cardiovasc Med. .

Abstract

Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.

Keywords: advanced heart failure; advanced therapies (ATs); heart transplant; ventricular assist device; women.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Influence of sex-steroid hormones on the cardiovascular system. Cardiomyocytes and vasculature have receptors for major female sex-steroid hormones; estrogen, progesterone and testosterone. These sex-steroid hormones influence heart failure progression through cellular mechanistic processes that have direct and indirect effects on the myocardium and vascular tone.
Figure 2
Figure 2
Evaluation of women for advanced heart failure therapies. Sex-specific factors affect hormonal levels and include pregnancy, lactation, contraception and menopause. Sex hormones influence heart failure progression and factors which are considered when evaluating women for advanced heart failure therapies. AHF, Advanced heart failure; LVAD, Left ventricular assist device.
Figure 3
Figure 3
Barriers to advanced heart failure therapies in women and proposed solutions. Organizational-related barriers can influence individual-related and provider-related barriers. Provider-related barriers can influence individual-related barriers. Factors that are more common in women appear in bold. HRSN, Health related social needs.
See this image and copyright information in PMC

References

    1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. . Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. (2021) 143:e254–743. 10.1161/CIR.0000000000000950 - DOI - PubMed
    1. Morris AA, Khazanie P, Drazner MH, Albert NM, Breathett K, Cooper LB, et al. . Guidance for timely and appropriate referral of patients with advanced heart failure: a scientific statement from the American Heart Association. Circulation. (2021) 144:e238–50. 10.1161/CIR.0000000000001016 - DOI - PubMed
    1. Fang JC, Ewald GA, Allen LA, Butler J, Westlake Canary CA, Colvin-Adams M, et al. . Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. J Card Fail. (2015) 21:519–34. 10.1016/j.cardfail.2015.04.013 - DOI - PubMed
    1. Chaudhry SP, Stewart GC. Advanced heart failure: prevalence, natural history, and prognosis. Heart Fail Clin. (2016) 12:323–33. 10.1016/j.hfc.2016.03.001 - DOI - PubMed
    1. Breathett K, Knapp SM, Carnes M, Calhoun E, Sweitzer NK. Imbalance in heart transplant to heart failure mortality ratio by sex. J Am Heart Assoc. (2021) 10:e020146. 10.1161/JAHA.120.020146 - DOI - PMC - PubMed

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