Disparities in Women with Heart Failure Authors
First Online: 12 April 2011 DOI:
Cite this article as: Chandrasekaran, S.A., Ventura, H.O., Lavie, C.J. et al. Curr Cardiovasc Risk Rep (2011) 5: 261. doi:10.1007/s12170-011-0170-8 Abstract
Despite comprising over half of the heart failure population, women have been under-represented in most major clinical heart failure trials. Women with heart failure are more likely to have a preserved systolic function, be older compared to men, and are more likely to have hypertension, diabetes, and obesity as the etiology of their heart failure. Furthermore, overall survival is better for women. These factors suggest that the disease process in women is not entirely the same as in men, and perhaps should not be treated the same. However, given the lack of prospective large number trials looking specifically at women and heart failure, there have been no statistically significant data to support tailoring medical therapy differently between men and women.
Keywords Women Heart failure Gender differences in heart failure References Papers of particular interest, published recently, have been highlighted as: • Of importance
• Pina, IL, Hsich, EM. Heart failure in women: a need for prospective data. J Am Coll Cardiology. 2009;42:491–7.
This review is an excellent synopsis of major heart failure trials and women, and it highlights the difficulty in extrapolating data from women in heart failure trials.
Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics-2008 update; a report from the American Heart Association Statistics Committee and Stroke Statistics SubCommittee. Circulation. 2008;117:e25–146.
Vasan RS, Larson MG, Benjamin EJ, et al. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population based cohort. J Am Coll Cardiol. 1999;33:1948–55.
Konhilas JP, Leinwand LA. The effects of biological sex and diet on the development of heart failure. Circulation. 2007;116:2747–59.
Levy D, Kenchiaiah S, Larson MG, et al. Long-term trends in heart failure incidence of and survival with heart failure. N Engl J Med. 2002;347:1397–402.
Owan TE, Hidge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.
Deswal A, Bozkurt B. Comparison of morbidity in women versus men with heart failure and preserved ejection fraction. Am J Cardiol. 2006;97:1228–31.
Johnstone D, Limacher M, Rousseau M, et al. Clinical characteristics of patients in studies of left centricular dysfunction (SOLVD). Am J Cardiol. 1992;70:894–900.
Galvao M, Kalman J, Demarco T, et al. Gender differences in in-hospital management and outcomes in patients with decompensated heart failure analysis from the acute decompensated failure national registry. J Card Fail. 2006;12:100–7.
Christ M, Laule-Kilian K, Hochholzer W, et al. Gender-specific risk stratification with V-type natriuretic peptide levels in patients with acute dyspnea:insights from the B-type natriuretic peptide for acute shortness of breath evaluation study. J Am Coll Cardiol. 2006;48:1808–12.
Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community based population. JAMA. 2004;292:344–50.
Ghali JK, Krause-Steinhrauf HJ, Adams KF, et al. Gender differences in advanced heart failure: insights from the BEST study. J Am Coll Cardiol. 2003;42:2128–34.
Ntusi NB, Mayosi BM. Etiology and risk factors of peripartum cardiomyopathy; a systematic review. Int J Cardiol. 2009;131(2):168–79.
Fett JD, Christie LG, Carraway RD, et al. Five year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single on. Mayo Clin Proc. 2005;80:1602–6.
Elkayam U, Tummala PP, Rao K, et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001;344:1567–71.
Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. US carvedilol Heart Failure Study Group. N Engl J Med. 1996;334:1349–55.
Hali JK, Pina IL, Gottlieb SS, et al. Metoprolol CR/XL in female patients with heart failure; analysis of the experience in Metoprolol Extended Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation. 2002;105:1585–91.
Effects of enalapril on mortality in severe congestive heart failure. Results of the cooperative North Scandinavian Enalapril Survival Study. The CONSENSUS Trial Study Group. N Engl J Med. 1987;316:1429–35.
Garg R, Yusuf S, Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. The Collaborative Group on ACE Inhibitor Trials. JAMA. 1995;273:1450–6.
Shekelle PG, Rich MW, Morton SC, et al. Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol. 2003;41:1529–38.
Cohn JN, Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001;345:1667–75.
Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341:709–17.
Pitt B, Zannad F, Remme WJ, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21.
Taylor AL, Lindenfeld J, Ziesche S, et al. Outcomes by gender in the African-American Heart Failure Trial. J Am Coll Cardiol. 2006;48:2263–7.
Dries DL, Rosenberg YD, Waclawiw MA, et al. Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm; evidence of gender differences in the studies of left ventricular dysfunction trials. J Am Coll Cardiol. 1997;29:1074–80.
Elmariah S, Goldberg LR, Allen MT, et al. Effects of gender on peak oxygen consumption and the timing of cardiac transplantation. J Am Coll Cardiol. 2006;47:2237–42.
Lavie CJ, Milani RV, Mehra MR. Peak exercise oxygen pulse and prognosis in chronic heart failure. Am J Cardiol. 2004;93:588–92.
Lavie CJ, Milano RV, Ventura HO, et al. Peak oxygen consumption and heart failure prognosis in women. J Am Coll Cardiol. 2007;36:2237–42.
Osman AF, Mehra MR, Lavie CJ, et al. The incremental prognostic importance of body fat adjusted peak oxygen consumption on chronic heart failure. J Am Coll Cardiol. 2000;36:2126–31.
Bristow MR, Saxon LA, Boehmer J, et al. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–50.
Zareba W, Moss AJ, Jackson Hall W, et al. Clinical course and implantable cardioverter defibrillator therapy in post infarction women with severe left ventricular dysfunction. J Cardiovasc Electrophysiol. 2005;16:1265–70.
• Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart failure events. N Engl J Med. 2009;361:1329–38.
This study suggests the underlying differences in heart failure therapy with CRT in women compared to men
• Arshad, A, Moss AJ, Foster E, et al. Cardiac Resynchronization Therapy is More Effective in Women than in Men. J Am Coll Cardiol 2011;57:814–820.
This paper clearly demonstrates a benefit in women with CRT compared to men.
• Slaughter, MS, Rogers, JG, Milano, CA, et al. Advanced Heart Failure Treated with Continuous Flow Left Ventricular Assist Devices. N Engl J Med. 2009;361:2241–51.
With the development and advances in mechanical device therapies for heart failure and observational data regarding complications and limitations, there are differences seen in the complications which arise for women with LVADs compared to men, and with the development of smaller devices the hope is that more women will be suitable candidates for LVADs and therefore more prospective data will be obtained
Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–50.
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