Women, men and heart failure: a review.

Chronic heart failure (HF) is a major cause of morbidity and mortality, and is the reason for more than one in five of all hospital admissions in patients aged >65 years. Major advances in the diagnosis and treatment of HF over the last two decades have proven effective in reducing morbidity and mortality among both men and women, but with less improvement for women and elderly patients. Women and men with HF differ in several respects. Women tend to be older and more often hypertensive, but are less likely to demonstrate any clinical evidence of coronary heart disease (CHD) and more often have preserved ventricular function. Conversely, hypertension plays a greater role in the development of HF in women than in men. Sex differences in systolic and diastolic function in patients with hypertension have been demonstrated. Although men have higher incidence of HF at all ages, lifetime risk is similar in men and women because women live longer. Intervention studies have included far more men than women but in patients with reduced ventricular function there is no evidence to suggest that women benefit less than men from evidence-based treatments, and current guidelines do not differentiate between men and women. There is no consistent recent evidence that women receive poorer quality of care than men. Women with HF have better survival rates than men, which may be due to better systolic function or less CHD among women; however, mortality rates for HF are still very high regardless of sex. As most trials have been targeted towards patients with left ventricular systolic dysfunction, which is less typical for women than for men with HF, more research is needed to help define treatment aimed at improving prognosis for patients with HF and preserved systolic function. In light of these differences and ongoing uncertainties, future European guidelines should incorporate gender issues. Heart Fail Monit 2008;6(1):34-40.