Heart Failure with Reduced Ejection Fraction in Women

Mentzer, Gina; Hsich, Eileen

doi:10.1016/j.hfc.2018.08.003

Cited by 53 publications

(62 citation statements)

References 45 publications

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“…The higher percentage of preserved ejection fraction among women was in line with findings reported by Buonanno,8,9 who pioneered the study of sex differences in the pathophysiology of HF, and is now widely observed in the literature 10. To date, HF guidelines do not take into account gender-specific differences due also to the underrepresentation of women in clinical trials,11 therefore analysis of data from the clinical setting can play an important role in improving the knowledge of gender-specific differences in the clinical presentation of HF. Similarly to data reported by Galvao et al's12 and Stein et al's13 studies, no differences were observed among genders for length of hospital stay.…”

supporting

confidence: 81%

<p>Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital</p>

Perrone¹,

Veronesi²,

Nica³

et al. 2019

TCRM

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Sex-related differences have been shown to deeply affect health-related aspects of patients. However, the lack of gender-specific analysis makes it difficult to advance personalized medicine in terms of a gender-based approach. The aim of the present study was to describe gender-specific features of patients diagnosed with heart failure (HF), with a focus on the clinical presentation. Data were collected from a properly designed database and referred to an Italian hospital. Patients aged ≥18 years with a primary or secondary diagnosis of HF between 1 January 2012 and 31 December 2016 were included, and their demographic and clinical characteristics were analyzed according to gender. Of the 719 HF patients included, 317 (44.1%) were male and 402 (55.9%) were female. Women tended to be older compared to men (82.4±8.8 years and 77.1±10.6 years, respectively). As for clinical presentation, 62.1% of female and 38.3% of male patients had preserved ejection fraction, and 56.1% of men and 58.2% of women suffered from atrial fibrillation. The left atrium was partially compromised in 62.4% of male and 63% of female patients, while right atrium dysfunction tended to be more frequent in male patients compared to female patients (29.1% and 25.5%, respectively). In conclusion, gender-specific features of a cohort of HF patients from a clinical setting were accurately described.

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supporting

confidence: 81%

<p>Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital</p>

Perrone¹,

Veronesi²,

Nica³

et al. 2019

TCRM

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“…Asian, Pacific Islander and other non‐white racial groups have limited representation in this trial. In addition, women continue to constitute a minority of patients with HFrEF in both registries and clinical trials 30 . Approximately 21% of the participants in GALACTIC‐HF were female, constituting a database of over 1700 women with HFrEF in whom the effects of omecamtiv mecarbil can be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC‐HF baseline characteristics and comparison with contemporary clinical trials

Teerlink

Dı́az

Felker

et al. 2020

European J of Heart Fail

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Aims The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is being tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and results Adults with established HFrEF, New York Heart Association (NYHA) functional class ≥II, ejection fraction ≤35%, elevated natriuretic peptides and either current hospitalization for heart failure or history of hospitalization/emergency department visit for heart failure within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5, or 50 mg bid). A total of 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean ejection fraction 27%, ischaemic aetiology in 54%, NYHA class II 53% and III/IV 47%, and median N‐terminal pro‐B‐type natriuretic peptide 1971 pg/mL. Heart failure therapies at baseline were among the most effectively employed in contemporary heart failure trials. GALACTIC‐HF randomized patients representative of recent heart failure registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure <100 mmHg (n = 1127), estimated glomerular filtration rate <30 mL/min/1.73 m2 (n = 528), and treated with sacubitril/valsartan at baseline (n = 1594). Conclusions GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation.

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“…Women are underrepresented in clinical trials investigating the efficacy of HF drugs, as only 10-40% of the patients included in these trials were women. 16 Furthermore, only one trial investigated efficacy prospectively stratified by sex, 17 while all other studies analysed sex-related effects retrospectively and in post-hoc analyses, limiting these results. In women, the use of ACE-is leads to a non-significant reduction in all-cause mortality and hospitalizations compared to placebo.…”

Section: Optimal Doses Of Hf Therapies In Men Versus Womenmentioning

confidence: 99%

Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction

Veenis

Rocca

Linssen

et al. 2020

European Journal of Preventive Cardiology

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Aims A recent study suggested that women with heart failure and heart failure reduced ejection fraction might hypothetically need lower doses of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers ( = renin-angiotensin-system inhibitors) and β-blockers than men to achieve the best outcome. We assessed the current medical treatment of heart failure reduced ejection fraction in men and women in a large contemporary cohort and address the hypothetical impact of changing treatment levels in women. Methods This analysis is part of a large contemporary quality of heart failure care project which includes 5320 (64%) men and 3003 (36%) women with heart failure reduced ejection fraction. Detailed information on heart failure therapy prescription and dosage were collected. Results Women less often received renin-angiotensin-system inhibitors (79% vs 83%, p < 0.01), but more often β-blockers (82% vs 79%, p < 0.01) than men. Differences in guideline-recommended target doses between sexes were relatively small. Implementing a hypothetical sex-specific dosing schedule (at 50% of the current recommended dose in the European Society of Cardiology guidelines in women only) would lead to significantly higher levels of women receiving appropriate dosing (β-blocker 87% vs 54%, p < 0.01; renin-angiotensin-system inhibitor 96% vs 75%, p < 0.01). Most interestingly, the total number of women with >100% of the new hypothetical target dose would be 24% for β-blockers and 52% for renin-angiotensin-system inhibitors, which can be considered as relatively overdosed. Conclusion In this large contemporary heart failure registry, there were significant but relatively small differences in drug dose between men and women with heart failure reduced ejection fraction. Implementation of the hypothetical sex-specific target dosing schedule would lead to considerably more women adequately treated. In contrast, we identified a group of women who might have been relatively overdosed with increased risk of side-effects and intolerance.

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Heart Failure with Reduced Ejection Fraction in Women

Cited by 53 publications

References 45 publications

<p>Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital</p>

<p>Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital</p>

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC‐HF baseline characteristics and comparison with contemporary clinical trials

Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction

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