Women With Heart Failure

SEE PAGE 29 I n the United States, and in most of the world, women make less money and have fewer job opportunities than men do, receive fewer college scholarships, and have more caregiving and childcare responsibilities, but are less likely to have a caregiver themselves when they are old and ill. Even their deaths have been systematically under-reported in newspaper obituary columns. To this long list of inequities, the management of women with heart failure (HF) is added. More than one-half of the 1 million patients newly diagnosed with HF in the United States annually are women (1). Many registries, randomized controlled studies, and population surveys have demonstrated that women presenting with HF are older, have a higher left ventricular ejection fraction, and have lower prevalence of ischemic heart disease and previous myocardial infarction than men do. Women with HF are more symptomatic, have more evidence of volume overload, have lower health-related quality of life, and have greater impairment in activities of daily living than men do. Despite this higher symptom burden, women have been under-enrolled in trials of HF pharmacologic and device therapies, most of which have examined treatment of HF with reduced ejection fraction (HFrEF) (2,3). Many of these trials have been underpowered to examine the sexspecific differences in therapeutic benefits or have