Heart failure (HF) has steadily increased in prevalence and affects both males and females equally. Despite this, there has been a significant underrepresentation of women in large scale HF trials. This disparity has lead to a deficit in understanding important gender-based differences in pathophysiology, diagnosis and treatment strategies. We review these gaps and explore a biological basis for varying outcomes. Endogenous estrogen plays an important role in epidemiology and outcome. The administration of exogenous estrogen has had varied success in treatment and is outlined extensively below. Additionally, we highlight unique HF syndromes through pregnancy and important sex-specific issues concerning transplant and mechanical circulatory support. A central theme remains: there is a clear need for increased female recruitment in clinical trials, and more studies exploring the role of gender-based biology in HF treatment.
IntroductionThe prevalence of heart failure (HF) has steadily increased and is now the leading cause of hospital admissions in the adult population in the United States. 1 Women constitute approximately one half of the patients hospitalized for HF, and deaths from HF contribute 35% of the total cardiovascular disease (CVD) mortality in women. 1 -3 Despite this, women have been historically under-represented in clinical HF trials. Although the population estimate of women among patients with HF in the Unites States is about 50%, only 17% to 23% of HF randomized controlled trials enrolled women. 4 This disparity has limited our understanding of gender-related differences in HF. The objective of this article is to review the relationships between sex and the epidemiology, etiology, clinical characteristics, therapeutic management, and outcomes in patients with HF.