Women with heart failure in Spain had more comorbidities, HFpEF, higher natriuretic peptides, but received less quadruple therapy and fewer referrals to rehab than men.
Do clinical characteristics and treatments differ between male and female patients with heart failure?
Women with heart failure in Spain present with different clinical profiles, including older age and more HFpEF, but are less likely to receive guideline-directed medical therapies and specialized follow-up compared to men.
Abstract Introduction Heart failure (HF) is a significant public health problem due to its high morbimortality and high consumption of healthcare resources. Several studies have pointed to some differences in the characteristics of women with HF compared to men, but the under-representation of women in the studies means that the evidence is limited. Purpose To analyse the differences in clinical characteristics of patients with HF according to sex. Methods A study was carried out, and patients were treated in HF units attached to the cardiology services of 68 hospitals in Spain with SEC-Excellent accreditation. The patients were included consecutively in two one-month cutoffs (March and October) between 2019 and 2023. The following data were collected: demographic, clinical, analytical, echocardiographic and treatment variables. For the differences between the two groups, the chi-square or Fisher's exact test was used, as appropriate, for qualitative variables and the Mann-Whitney U test for quantitative variables. Results 2,481 patients were included, 879 (35.4%) female. Women were older than men (71 (62;79) vs. 77 (68;83), p0.001). Most of the patients were included during the hospitalisation and were followed in specialised (62.8 vs 66.4 ) or community (21.9 vs 20.3) HF units, without differences according to sex (p=0.176). Most patients are newly diagnosed HF patients, without differences according to sex (59.9 vs 59.8 %; p=0.967). In those with chronic HF, there were no differences in the percentage of patients with HF admission the previous year (32.4 vs. 32.9; p=0.790). Women had more hypertension, valvular heart disease and comorbidities (except respiratory ones) and less ischaemic heart disease. They also had more atrial fibrillation and more often preserved LVEF (table 1). Women had higher natriuretic peptide levels and lower glomerular filtration rates. In terms of treatment, they had fewer devices, less frequent use of quadruple therapy drugs, and more frequent receiving diuretic treatment. Finally, women were less frequently referred to cardiac rehabilitation programmes and structured follow-up in HF units (table 2). Conclusions In our cohort of HF patients, women had more comorbidities and more frequent HFpF than men. Implementation of drugs with prognostic benefit was lower, and referral to specialised HF and cardiac rehabilitation programmes was less frequent than in men.Table 1 Table 2
Fernandez et al. (2025) studied this question. Women with heart failure in Spain had more comorbidities, HFpEF, higher natriuretic peptides, but received less quadruple therapy and fewer referrals to rehab than men.