Differential impact of heart failure with reduced ejection fraction on men and women

Dewan, P. et al. (2019) Differential impact of heart failure with reduced ejection fraction on men and women. Journal of the American College of Cardiology, 73(1), pp. 29-40. (doi: 10.1016/j.jacc.2018.09.081) (PMID:30621948)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Roerth, Dr Rasmus and Dewan, Dr Pooja and Jhund, Professor Pardeep and Mogensen, Dr Ulrik and Shen, Dr Li and Petrie, Professor Mark and McMurray, Professor John and Kober, Professor Lars
• Authors: Dewan, P., Rørth, R., Jhund, P. S., Shen, L., Raparelli, V., Petrie, M. C., Abraham, W. T., Desai, A. S., Dickstein, K., Køber, L., Mogensen, U. M., Packer, M., Rouleau, J. L., Solomon, S. D., Swedberg, K., Zile, M. R., and McMurray, J. J.V.
• Subjects: R Medicine > RZ Other systems of medicine
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of the American College of Cardiology
• Journal Abbr.: JACC
• Publisher: Elsevier
• ISSN: 0735-1097
• ISSN (Online): 1558-3597
• Published Online: 07 January 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Journal of the American College of Cardiology 73(1): 29-40
• Publisher Policy: Reproduced under a Creative Commons License