Gender-Specific Physical Symptom Biology in Heart Failure

Abstract

Background There are several gender differences that may help explain the link between biology and symptoms in heart failure (HF). Objective The aim of this study was to examine gender-specific relationships between objective measures of HF severity and physical symptoms. Methods Detailed clinical data, including left ventricular ejection fraction and left ventricular internal end-diastolic diameter, and HF-specific physical symptoms were collected as part of a prospective cohort study. Gender interaction terms were tested in linear regression models of physical symptoms. Results The sample (101 women and 101 men) averaged 57 years of age and a majority of participants (60%) had class III/IV HF. Larger left ventricle size was associated with better physical symptoms for women and worse physical symptoms for men. Conclusion Decreased ventricular compliance may result in worse physical HF symptoms for women and dilation of the ventricle may be a greater progenitor of symptoms for men with HF.

Patterns of heart failure symptoms are associated with self-care behaviors over 6 months

“…One explanation for more women being in the HSS group may be related to physiological differences in the ventricular size and function in women and men with HF. 28 For instance, it has been shown that women with HF have smaller and stiffer ventricles with higher filling pressures than men, possibly contributing to more physical symptoms in women with HF. 28,29 In addition, our observation that women were significantly more likely to be in the HSS group may explain, in part, reports from other studies describing women with HF having lower health-related quality of life compared to men.…”

“…28 For instance, it has been shown that women with HF have smaller and stiffer ventricles with higher filling pressures than men, possibly contributing to more physical symptoms in women with HF. 28,29 In addition, our observation that women were significantly more likely to be in the HSS group may explain, in part, reports from other studies describing women with HF having lower health-related quality of life compared to men. 30,31 Thus, our study highlights the importance of gender in HF, and suggests clinicians and researchers consider gender in developing treatment plans and research projects addressing HF symptoms.…”

“…Gender differences in physical HF symptoms have been noted in previous studies. Lee et al 28 demonstrated that gender moderated the association of physical symptoms with left ventricular diameter such that women with smaller ventricles experience a worse symptom burden compared to men with smaller ventricles. Gori et al 29 found women to be more symptomatic assessed with NYHA class compared to men.…”

Comparative symptom biochemistry between moderate and advanced heart failure

“…There is more recent evidence of biomechanical underpinnings of HF symptoms 13,14 as well as biochemical links between symptoms and HF severity including an objective metric of adrenergic dysregulation that was shown recently to be associated with a composite score of physical HF symptoms. 15 Hence, one reason for limited evidence connecting symptoms and objective markers of HF may be that we have been looking at the wrong metrics to test such associations.…”

Exploring the relationship between β-adrenergic receptor kinase-1 and physical symptoms in heart failure

“…hemodynamics) and what patients experience symptomatically, [4][5][6] this is an important next step in identifying a biological underpinning of physical symptoms in HF. These findings, coupled with other advances in HF symptom biology, 19,20 could inform conversations in clinical settings, especially when eliciting information regarding symptom burden. Moreover, these results could provide an amenable target for ameliorating symptom burden through interventions directed at reducing sympathetic overdrive, including a combination of pharmacological, exercise, and self-care interventions.…”