Women with heart failure predominantly presented with HFpEF and were less likely to receive optimal therapies compared to men, reflecting significant sex-based differences in management.
Are there sex-related differences in the presentation, management, and outcomes of heart failure among outpatients with type 2 diabetes?
Among outpatients with type 2 diabetes, women and men have similar heart failure prevalence and mortality, but women are more likely to present with HFpEF and less likely to receive guideline-directed medical therapy for HFrEF.
Background: Heart failure (HF) and type 2 diabetes (T2D) frequently coexist and contribute to adverse outcomes. We aimed to explore sex-related differences in HF presentation and outcomes in a nationwide cohort of T2D outpatients. Materials and Methods: We analyzed a prospective cohort of 1,249 T2D outpatients recruited from cardiology and endocrinology clinics across 30 Spanish centers. HF was classified according to left ventricular ejection fraction (LVEF) into reduced (HFrEF; LVEF <40%), mid-range (HFmrEF; LVEF 40–49%), and preserved ejection fraction (HFpEF; LVEF ≥50%). Sex-related differences in HF characteristics, treatment, and 3-year clinical outcomes were assessed. Results: HF prevalence did not differ significantly between women and men (initial visit: 37.2% versus 40.4%, p = 0.285; 3-year visit: 45.9% versus 51.7%, p = 0.294). However, HFpEF predominated among women and HFrEF among men ( p < 0.001). HF was associated with increased mortality (odds ratio 4.26; 95% confidence interval, 2.65–7.04; p < 0.001), with no interaction by sex (p for interaction = 0.326). Women with HFrEF were less likely to receive angiotensin receptor–neprilysin inhibitors (44.2% versus 62.9%, p = 0.035). Among HFpEF patients, women were more frequently treated with diuretics (82.4% vs 66.5%, p = 0.009). Conclusion: Despite similar prevalence and prognosis, women were more likely to present with HFpEF and were less likely to receive optimal guideline-directed therapies, underscoring sex-based differences in both the presentation and management of HF.
Manzanares et al. (2025) studied this question. Women with heart failure predominantly presented with HFpEF and were less likely to receive optimal therapies compared to men, reflecting significant sex-based differences in management.