Differences in presentation, diagnosis and management of heart failure in women. A scientific statement of the Heart Failure Association of the ESC

• Published in: European journal of heart failure Vol. 26; no. 8; pp. 1669 - 1686
• Main Authors: Rosano, Giuseppe M.C., Stolfo, Davide, Anderson, Lisa, Abdelhamid, Magdy, Adamo, Marianna, Bauersachs, Johann, Bayes‐Genis, Antoni, Böhm, Michael, Chioncel, Ovidiu, Filippatos, Gerasimos, Hill, Loreena, Lainscak, Mitja, Lambrinou, Ekaterini, Maas, Angela H.E.M., Massouh, Angela R., Moura, Brenda, Petrie, Mark C., Rakisheva, Amina, Ray, Robin, Savarese, Gianluigi, Skouri, Hadi, Van Linthout, Sophie, Vitale, Cristiana, Volterrani, Maurizio, Metra, Marco, Coats, Andrew J.S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01-08-2024
• Subjects: Device; Disease Management; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - therapy; Humans; Medical therapy; Medicin och hälsovetenskap; Prognosis; Risk factor; Sex; Sex Factors; Societies, Medical; Women; Heart failure; Women; Medical therapy; Device; Risk factor; Sex
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1002/ejhf.3284

Despite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex‐specific conditions in the predisposition to HF has gained progressive interest in the HF community. Under‐recruitment of women in large randomized clinical trials has continued in the more recent studies despite epidemiological data no longer reporting any substantial difference in the lifetime risk and prognosis between sexes. Target dose of medications and criteria for device eligibility are derived from studies with a large predominance of men, whereas specific information in women is lacking. The present scientific statement encompasses the whole scenario of available evidence on sex‐disparities in HF and aims to define the most challenging and urgent residual gaps in the evidence for the scientific and clinical HF communities.
Sex‐based differences in heart failure (HF) encompass the complete scenario of the disease, from pre‐clinical studies to advanced therapeutic strategies. The progresses in knowledges made available multiple information for researchers and clinicians, which aids to understand the underlying mechanisms and to define how to apply information to clinical‐decision making. However, several residual scientific and clinical gaps must be filled in order to finally eliminate sex disparities in the management of HF. AHF, acute heart failure; ARNI, angiotensin receptor–neprilysin inhibitor; CRT, cardiac resynchronization therapy; EF, ejection fraction; GDMT, guideline‐directed medical therapy; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter‐defibrillator; MCS, mechanical circulatory support; MRA, mineralocorticoid receptor antagonist; NP, natriuretic peptide; QoL, quality of life; RCT, randomized clinical trial; SCD, sudden cardiac death; SGLT2i, sodium–glucose cotransporter 2 inhibitor.