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Guideline-Directed Medical Therapy in Females with Heart Failure with Reduced Ejection Fraction

  • Sex and Gender Aspects in Heart Failure (G. Figtree and C. Arnott, Section Editors)
  • Published:
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Abstract

Purpose of Review

This narrative review synthesizes sex differences in guideline-directed medical therapy (GDMT) use and response among female patients with heart failure with reduced ejection fraction (HFrEF), discusses female representation in HFrEF clinical trials, and outlines future areas of investigation to reduce sex disparities in HFrEF care globally.

Recent Findings

Observational registries suggest sex-specific disparities persist in GDMT rates, and there may be key sex-specific differences in optimal dosing of GDMT in HFrEF patients. Underrepresentation of female patients in HF clinical trials is a key barrier, and sex disparities in HF clinical trial leadership may influence sex-specific knowledge generation of medical management of HFrEF patients.

Summary

There are important sex-specific differences in GDMT use and response among female HFrEF patients that warrant further study. Increasing female representation in HFrEF clinical trials, diversifying HF trial leadership, and embedding sex-specific approaches in the lifecycle of research from conception to reporting are essential to decreasing sex disparities in clinical care of all HFrEF patients.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Anubha Agarwal

  2. George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK

    Sanne A. E. Peters

  3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

    Sanne A. E. Peters

  4. George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

    Sanne A. E. Peters & Clare Arnott

  5. National Heart Centre Singapore, Singapore, Singapore

    Chanchal Chandramouli & Carolyn S. P. Lam

  6. Duke University-National University of Singapore Graduate Medical School, Singapore, Singapore

    Carolyn S. P. Lam

  7. Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia

    Gemma A. Figtree

  8. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

    Clare Arnott

Authors
  1. Anubha Agarwal
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  2. Sanne A. E. Peters
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  3. Chanchal Chandramouli
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  4. Carolyn S. P. Lam
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  5. Gemma A. Figtree
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  6. Clare Arnott
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Corresponding author

Correspondence to Anubha Agarwal.

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Conflicts of Interest

Anubha Agarwal plans to submit a patent for heart failure polypills including for heart failure with reduced ejection fraction.

Sanne AE Peters reports no conflicts of interest.

Chanchal Chandramouli reports grants from National Medical Research Council Singapore, philanthropic research grants from Lee Foundation Singapore other from Boehringer Ingelheim and Sanofi Aventis.

Carolyn SP Lam reports grants from National Medical Research Council Singapore, non-financial support from Boston Scientific, non-financial support and other from Bayer, non-financial support from Thermofisher, non-financial support from Vifor Pharma, other from Takeda, other from Merck, other from Astra Zeneca, other from Janssen Research & Development, other from LLC, other from Menarini, other from Boehringer Ingelheim, other from Abbott Diagnostics, other from DC Devices, other from PCT/SG2016/050217 Patent pending, outside the submitted work.

Gemma A Figtree has received research support from the cofunded Australian National Health and Medical Research Council and Heart Foundation fellowship and Heart Research Australia; and has received compensation from Janssen for serving on the adjudication panel of the CANVAS Program.

Clare Arnott is supported by a NSW Health Early-Mid Career Fellowship and NHMRC/MRFF Priority Investigator Grant.

Human and Animal Rights and Informed Consent

Informed consent was obtained in all studies with human participants performed by any of the authors. This article does not contain any studies with animal subjects.

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Agarwal, A., Peters, S.A.E., Chandramouli, C. et al. Guideline-Directed Medical Therapy in Females with Heart Failure with Reduced Ejection Fraction. Curr Heart Fail Rep 18, 284–289 (2021). https://doi.org/10.1007/s11897-021-00524-z

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