Sexual Health in Heart Failure: How Age, Sex, and Dyspnea Interact to Shape Intimacy and Unmet Clinical Needs

AIMS: Sexual health is a cornerstone of well-being among the least explored aspects of heart failure (HF) care. Guidelines offer minimal, male-focused recommendations, leaving female sexual health underaddressed. The ROMANT'IC study investigated how HF affects intimacy and sexuality across sex, age and symptom burden. METHODS AND RESULTS: ROMANT'IC was a national descriptive questionnaire study including1,398 patients with HF (921 men, 477 women; age 18-93 years). Overall, 655 (46.9%) provided detailed responses:491 (53.3%) men, 164 (34.4%) women indicating a reluctance to disclose information on sexuality (p<0.001). 57.8% men, and 53.7% women reported no sexual activity in the previous three months. Sexual inactivity varied significantly across age groups (χ2=17.02, p=0.001): 52.9% at 18-40 years, 50.0% at 41-55 years, 48.3% at 56-65 years, and 65.5% at ≥66 years and increased markedly with dyspnea severity: 47.8% at Grade 1, 50.3% at Grade 2, and 79.0% at Grades 3-4 (χ2=40.96, p<0.001). Men reported erectile dysfunction (49.0%) and treatment side effects (39.5%); women reported loss of desire (65.4%), reduced sense of seductiveness (61.5%), and depression (42.3%). Severe dyspnea independently predicted sexual inactivity (OR=3.88 [2.26-6.64], p<0.001), whereas sex and age were not significant after adjustment. Overall, 72-80% had never discussed sexuality with their cardiologist, regardless of dyspnea severity or age. CONCLUSION: HF profoundly alters sexuality. Dyspnea severity is the dominant independent driver of sexual inactivity and represents a potentially modifiable therapeutic target. These findings call for systematic, gender- and age-sensitive, dyspnea-graded sexual counselling in routine HF care.