Heart failure with reduced ejection fraction: Influence of gender on clinical characteristics, cardiac remodeling and neurohormonal response

Abstract

Introduction

It is estimated that 30−50% of patients with heart failure with reduced ejection fraction (HFrEF) are women. This population appears to differ in terms of clinical characteristics, aetiology and treatment optimisation compared to men. Our main objective was to analyse these considerations, the influence of female sex on cardiac remodelling and neurohormonal response, as well as their impact on medium- to long-term prognosis.

Métodos

Retrospective study of a cohort of HFrEF patients from real clinical practice. A comparative analysis was performed between male and female patients.

Resultados

409 patients were analysed, a total of 106 females (25.4%), with a higher mean age than males (71.4 ± 13.8 vs. 66 ± 11.9; p < 0.001), higher prevalence of de novo HF (66.6% vs. 51.5%; p = 0.009), with a shorter HF evolution time (18.4 ± 42.6 vs. 42.8 ± 75.6 months; p = 0.001). Without significant differences in treatment optimisation, women had better cardiac remodelling at follow-up, as well as better neurohormonal response, with higher % reduction of NT-proBNP [−61,9% vs. −54,2%; p < 0.01], and of CA125 [−63,4% vs. −50,9%; p < 0.01]. With a median follow-up of 5 years, there were no differences in hospital readmissions or HF mortality in both sexes.

Conclusiones

Women with HFrEF have different clinical and aetiological characteristics compared to men. In evolution, they have better cardiac remodelling and neurohormonal response, although this has no impact on prognosis, readmission or mortality due to heart failure.