Key result
Women show higher HFpEF incidence than men but trial underrepresentation limits actionable data.
Why the study?
Key gaps persist in understanding gender-based differences in HF, data on sex- and gender-specific efficacy of evidence-based therapies remain limited, and underrepresentation of women and gender minorities in clinical trials limits actionable evidence.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Heart failure with preserved ejection fraction is underdiagnosed, particularly in women. We don't listen to women's symptoms or take them as seriously and it can be challenging.”
“We need to recognize and personalize our approach to these therapies for men and women.”
“HF tends to present at a more advanced stage in women, but women still represent half of all incident HF cases. We also know that more than half of all people who die from HF are women. Despite this, women have been significantly underrepresented in HF clinical trials, accounting for only 20% to 25% of study participants.”
Sex differences in HF traits merit attention in trial design; leaves open whether tailored therapies improve outcomes.
Sex-based differences exist in risk, symptoms, and management of heart failure (HF). Women have a higher incidence of HF with preserved ejection fraction compared with men. This may be partially caused by the cardiovascular effects of estrogen and sex-specific risk factors (eg, adverse pregnancy outcomes, premature menopause). Key gaps exist in understanding of gender-based differences in HF, which is a distinctly different concept than sex-based differences. Although evidence-based therapies for HF are available, only limited data address sex-specific efficacy, and no data address gender-based efficacy. Persistent shortcomings in representation of women and gender minority participants in clinical trials limit an actionable database. A comprehensive roadmap to close the sex/gender-based gap in HF includes the following: 1) sex/gender-specific personalized prevention; 2) sex/gender-neutral implementation of evidence-based therapies; and 3) sex/gender-appropriate policy-level initiatives to spur research assessing sex/gender-specific causes of HF; enhance sex/gender-specific subgroup reporting; and promote community engagement of these important patient cohorts.
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Khan et al. (2022) conducted a review in Heart failure. Sex and gender was evaluated. Sex-based differences exist in heart failure, with women having a higher incidence of HFpEF than men, though limited representation in clinical trials restricts actionable sex-specific data.
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