Gender differences in advanced heart failure: insights from the BEST study

Ghali, Jalal K.; Krause‐Steinrauf, Heidi; Adams, Kirkwood F.; Khan, Steven S.; Rosenberg, Yves; Yancy, Clyde W.; Young, James B.; Goldman, Steven; Peberdy, Mary Ann; Lindenfeld, JoAnn

doi:10.1016/j.jacc.2003.05.012

Cited by 258 publications

(160 citation statements)

References 32 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…disease resulting in left ventricular dysfunction may have a mortality similar to men with ischemic disease. 6,7 The Olmsted County data showed that the incidence of HF did not decline between 1979 and 2000, but the survival rate improved overall, with less improvement among women and elderly persons. 5 Previous studies have shown that women treated for chronic HF are more likely than men to have HF with preserved ejection fraction (HFPEF).…”

Section: Epidemiologymentioning

confidence: 99%

“…11 In both men and women, the prognosis is better in nonischemic disease causes. 6 The mortality disparity between women and men may be due to the higher incidence of HFPEF in women, with a suggestion that HFPEF patients overall have a better prognosis than HF patients with impaired systolic function. 12 The difference in survival may also be related to sex-related differences in HF etiology, as women have less ischemic cardiomyopathy compared to men.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…12 The difference in survival may also be related to sex-related differences in HF etiology, as women have less ischemic cardiomyopathy compared to men. 6,13 Among patients with reduced ejection fraction (EF), women have more frequent and prolonged hospitalizations than men. 14 The relative roles of risk factors influencing the development of HF, such as age, coronary disease, diabetes, and hypertension, are different in men and women.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…Experience from the Beta-Blocker Evaluation of Survival Trial (BEST) echoed this finding and additionally noted several other important observations. 6 Women had a higher prevalence of nonischemic etiology (which in turn conferred an improved survival), higher left ventricular EF, a lower occurrence of atrial fibrillation, and a higher prevalence of left bundle branch block.…”

Section: Gender Differences In Presentationmentioning

confidence: 99%

“…Pooled data from 3 large studies-Metoprolol CR/XL Randomised Intervention Trial in Heart Failure (MERIT-HF), Carvedilol Prospective Randomized Cumulative Survival Trial (COPERNICUS), and the Cardiac Insufficiency Bisoprolol Study II (CIBIS II) suggest that β blockade leads to similar decreases in mortality among men and women. 6 If each trial is examined separately, this similarity is not evident, and it may be concluded that women do not fare as well as men with β-blocker therapy. Only in combining the data is there a significant benefit noted, a fact that again highlights the need for greater enrollment of women.…”

Section: Hf Therapiesmentioning

confidence: 99%

See 4 more Smart Citations

Heart Failure in Women

Shin

Hamad

Murthy

et al. 2012

Clinical Cardiology

View full text Add to dashboard Cite

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.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Gender Differences In Presentationmentioning

confidence: 99%

Section: Hf Therapiesmentioning

confidence: 99%

See 3 more Smart Citations

Heart Failure in Women

Shin

Hamad

Murthy

et al. 2012

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

Efficacy and Safety of Dapagliflozin in Men and Women With Heart Failure With Reduced Ejection Fraction

et al. 2021

View full text Add to dashboard Cite

IMPORTANCEWomen may respond differently to certain treatments for heart failure (HF) with reduced ejection fraction (HFrEF) than men.OBJECTIVE To investigate the efficacy and safety of dapagliflozin compared with placebo in men and women with HFrEF enrolled in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF).DESIGN, SETTING, AND PARTICIPANTS Prespecified subgroup analysis of a phase 3 randomized clinical trial conducted at 410 sites in 20 countries. Patients with New York Heart Association functional class II through IV with an ejection fraction of 40% or less and elevated N-terminal pro-B-type natriuretic peptide were eligible. Data were analyzed between June 2020 and January 2021.INTERVENTIONS Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. MAIN OUTCOMES AND MEASURESThe primary outcome was the composite of an episode of worsening HF (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death.RESULTS A total of 4744 patients were randomized in DAPA-HF, of whom 1109 were women (23.4%). Compared with placebo, dapagliflozin reduced the risk of worsening HF events or cardiovascular death to a similar extent in both men and women (hazard ratios, 0.73 [95% CI, 0.63-0.85] and 0.79 [95% CI, 0.59-1.06], respectively; P for interaction = .67). Consistent benefits were observed for the components of the primary outcome and all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement in symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score of Ն5 points; men, 59% vs 50%; women, 57% vs 54%; P for interaction = .14) and decreased the proportion with worsening symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score decrease of Ն5 points; men, 25% vs 34%; women, 27% vs 31%; P for interaction = .15), irrespective of sex. Results were consistent for the Kansas City Cardiomyopathy Questionnaire clinical summary score and overall summary score. Study drug discontinuation and serious adverse events were not more frequent in the dapagliflozin group than in the placebo group in either men or women.CONCLUSIONS AND RELEVANCE Dapagliflozin reduced the risk of worsening HF, cardiovascular death, and all-cause death and improved symptoms, physical function, and health-related quality of life similarly in men and women with heart failure and reduced ejection fraction. In addition, dapagliflozin was safe and well-tolerated irrespective of sex.

show abstract