Gender Differences in Heart Failure: Findings from Italian Internal Medicine Wards
American Journal of Internal Medicine
Volume 3, Issue 2, March 2015, Pages: 55-66
Received: Feb. 19, 2015; Accepted: Mar. 5, 2015; Published: Mar. 18, 2015
Views 2863      Downloads 138
Paolo Biagi, Medicina Interna Ospedale di Montepulciano, Montepulciano (SI), Italy
Valerio Verdiani, Medicina Interna Ospedale della Misericordia, Grosseto, Italy
Niccolo’ Napoli, Scuola di Specializzazione Chirurgia Generale Universitaria di Pisa, Pisa, Italy
Cristiana Seravalle, Medicina Interna Ospedale S Maria Nuova, Firenze, Italy
Luca Masotti, Medicina Interna Ospedale S Maria Nuova, Firenze, Italy
Irene Chiti, Medicina Interna Ospedale SS Cosma e Damiano di Pescia, Pescia (PT), Italy
Grazia Panigada, Medicina Interna Ospedale SS Cosma e Damiano di Pescia, Pescia (PT), Italy
Article Tools
Follow on us
Background and aim: Literature evidence shows that about one half of patients with heart failure (HF) are females. However, they are poorly represented in clinical trials. Therefore, this syndrome remains still understood and its burden underestimated in female sex. The aim of our study was to compare demography, etiology, clinical patterns, outcome, co-morbidity, disability and cognitive performance between females and males in a cohort of patients with HF. Materials and methods: We analyzed data of the Confine Study, a recently real world survey performed in Italian Internal Medicine wards. We compared clinical and instrumental characteristics between males and females. Results: Females with HF were significantly older than men. Hypertensive and valvular etiologies were significantly more prevalent in females whereas ischemic and dilatative were in males. Neither clinical aspects, with the exception of atrial fibrillation, nor echocardiographic aspects were more frequent in females. According to international guidelines on topic, both sexes received under-treatment, but this one was more evident in females. Females presented more frequently cognitive impairment and functional disability than males. Conclusion: Female sex is under-represented in clinical trials on HF. Our study may provide a contribute on this topic.
Heart Failure, Gender, Therapy, Symptoms, Diagnosis, Epidemiology, Internal Medicine
To cite this article
Paolo Biagi, Valerio Verdiani, Niccolo’ Napoli, Cristiana Seravalle, Luca Masotti, Irene Chiti, Grazia Panigada, Gender Differences in Heart Failure: Findings from Italian Internal Medicine Wards, American Journal of Internal Medicine. Vol. 3, No. 2, 2015, pp. 55-66. doi: 10.11648/j.ajim.20150302.13
Levy D, Kenchaiah S, Larson MG, Benjiamin EJ, Kupka MJ, Ho KL et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002; 347: 1397-1402
Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP et al. Trends in heart failure incidence and survival in a community-based population. JAMA 2004; 292: 344-350
Rosamond W, Flegal K, Furie K. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25–146.
Hsich, E M, Piña, I L. Heart Failure in WomenA Need for Prospective Data. J Am CollCardiol 2009; 54:491–8
Shah R U , Klein L, Lloyd-Jones DM . Heart Failure in Women: Epidemiology, Biology and Treatment Women's Health. 2009; 5: 517-527.
Galvao M, Kalman J, DeMarco T, Fonarow GC, Galvao C, Ghali JK et al. Gender differences in in-hospital management and outcomes in patients with decompensated heart failure: analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Card Fail 2006;12:100 –107.
Nieminen MS, Harjola VP, Hochadel M, Drexler H, Komajda M, Brutsaert D et al. Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II. Eur J Heart Fail 2008;10:140–148.
Di Lenarda A, Scherillo M, Maggioni AP, Acquarona N, Ambrosio GB, Annichiarico M et al. and TEMISTOCLE Investigators. Current presentation and management of heart failure in cardiology and internal medicine hospital units: a tale of two worlds—the TEMISTOCLE study. Am Heart J 2003;146:E12.
Biagi P, Gussoni G, Iori I, Nardi R, Mathieu G, Mazzone et al. on behalf of the CONFINE Study Group. Clinical profile and predictors of in-hospital outcome in patients with heart failure: The FADOI “CONFINE” Study, Int J Cardiol 2011, doi:10.1016/j.ijcard.2011.02.025
Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M et al. Guidelines for the diagnosis and treatment of chronic heart failure—executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. EurHeart J 2005;26:1115–40.
Mancia G, de Backer G, Dominiczak A, Cifkova R, Fagar R, Germano G et al. Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology(ESC). J Hypertens 2007;25:1105–87.
Nutritional Anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 1968;405:1–40.
Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J AmGeriatrSoc 1975;23:433–4
Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965;14:61–5
Rector TS, Kubo SH, Cohn JN. Patients' self-assessment of their congestive heartfailure. Pt 2. Content, reliability, and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. HeartFail J 1987;3:198–208.
Frazier CG, Alexander KP, Newby LK, Anderson S, Iverson E, Packer M et al.: Associations of gender and etiology with outcomes in heart failure with systolic dysfunction: a pooled analysis of 5 randomized control trials. J. Am. Coll. Cardiol. 2007;49, 1450-1458
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK: The progression from hypertension to congestive heart failure. JAMA 1996;275, 1557-1562.
Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aquilar JC et al.; Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology: The EuroHeart Failure Survey programme - a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur. Heart J. 2003, 24, 442-463
Johnstone D, Limacher M, Rousseau M, Liang CS, Ekelund L, Herman M et al. Clinical characteristics of patients in studies of left ventricular dysfunction (SOLVD). Am J Cardiol 1992;70:894 –900
Masoudi FA, Havranek EP, Smith G, Fish RH, Steiner JC, Ordin DL et al.: Gender, age, and heart failure with preserved left ventricular systolic function. J. Am. Coll. Cardiol. 2003, 41, 217-223
Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D: Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J. Am. Coll. Cardiol. 1999, 33, 1948-1955
Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, ADHERE Scientific Advisory Committee and Investigators: Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J. Am. Coll. Cardiol. 2006, 47, 76-84.
Biagi P, Abate L, Alessandri M, Bocchini S, Verdiani V, Pettinà G et al. Heart failure with preserved systolic function: prevalence and clinical features in a cohort of patients admitted to internal medicine units. The study PRESYF-HF Tuscany. Monaldi Arch Chest Dis 2007; 68: 165-169.
Cirillo M, Laurenzi M, Mancini M, Zanchetti A, Lombardi C, De Santo NG: Low glomerular filtration in the population: prevalence, associated disorders, and awareness.Kidney Int 2006, 70:800-806
Minasa M, Hatzogloua C. Karetsia E, Papaioannou A I, Tanoua K, Tsarouchaa R et al. COPD prevalence and the differences between newly and previously diagnosed COPD patients in a spirometry program Primary Care Respiratory Journal 2010; 19: 363-370.
Ghali JK, Krause-Steinrauf HJ, Adams KF, Khann SS, Rosembreg JD, Yancy CV et al.: Gender differences in advanced heart failure: insights from the BEST study. J. Am. Coll. Cardiol. 2003; 42, 2128-2134
Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P: Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation 2001;103, 375-380.
Kenchaiah S, Evans JC, Levy D, Wilson PWF, Benjamin EJ, Larson MG et al.: Obesity and the risk of heart failure. N. Engl. J. Med. 2002; 347, 305-313
Wang J, Sarnola K, Ruotsalainen S, Moilanen L, Lepisto P, Laakso M, et al. The metabolic syndrome predicts incident congestive heart failure: A 20-year follow-up study of elderly Finns. Atherosclerosis 2010; 210: 237 – 242.
Bahrami H, Bluemke DA, Kronmal R, Bertoni AG, Lloyd-Jones DM, Shahar E, et al. Novel metabolic risk factors for incident heart failure and their relationship with obesity: The MESA (Multi- Ethnic Study of Atherosclerosis) study. J Am CollCardiol 2008;51: 1775 – 1783.
Ingelsson, E, Sundström, J, Ärnlöv, J, Zethelius, B, Lindt, L Insulin resistance and risk of congestive heart failure. JAMA 2005; 294: 334–40.
Ingelsson E, Arnlov J, Lind L, Sundstrom J. Metabolic syndrome and risk for heart failure in middle-aged men. Heart 2006;92:1409 –13.
Biagi P, Nardi R, Mathieu G, Vescovo G, Scanelli G, on behalf of the CONFINE Study Group. Metabolic syndrome and heart failure: Data from the FADOI CONFINE study. It. J. Intern Med 2014;8: 169-175
Rathore SS, Foody JM, Wang Y et al.: Sex, quality of care, and outcomes of elderly patients hospitalized with heart failure: findings from the National Heart Failure Project. Am. Heart J. 2005;149, 121-128
Lenzen MJ, Rosengren A, Scholte op Reimer WJ, Follath F, Boersma E, Simoons ML et al.: Management of patients with heart failure in clinical practice: differences between men and women. Heart 94, 2008E10
O'Meara E, Clayton T, McEntegart MB, McMurray JJ, Pina L, Granger CB et al.: Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Circulation 2007; 115, 3111-3120
Ghali JK, Pina IL, Gottlieb SS, Deedwania PC, Wikstrand JC: Metoprolol CR/XL in female patients with heart failure: analysis of the experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation 2002, 105, 1585-1591.
MERIT HF study Group.Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 353, 2001-2007 (1999). .
Packer M, Fowler MB, Roecker EB, Coats AJG, Katus HA, Krum H et al.: Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study. Circulation 2002, 106, 2194-2199.
Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G et al: Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000;355, 1575-1581.
Jong P, Yusuf S, Rousseau MF, Ahn SA, Bangdiwala SI: Effect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction: a follow-up study. Lancet 2003;361, 1843-1848.
Shekelle PG, Rich MW, Morton SC, Atkinson CS, Tu W, Maglione M et al. Efficacy of angiotensinconverting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J AmCollCardiol 2003;41:1529 –38.
Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I et al: Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997;349, 747-752 .
Hudson M, Rahme E, Behlouli H, Sheppard R, Pilote L: Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure - a population study. Eur. J. HeartFail. 2007, 9, 602-609.
The Digitalis Investigation Group: The effect of digoxin on mortality and morbidity in patients with heart failure. N. Engl. J. Med. 1997;336, 525-533.
Rathore SS, Wang Y, Krumholz HM: Sex-based differences in the effect of digoxin for the treatment of heart failure. N. Engl. J. Med. 347, 2002; 1403-1411
Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS et al.: Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur. Heart J. 2006;27, 178-186
Dries DL, Rosenberg YD, Waclaw MA, Domanski MJ. Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. J AmCollCardiol 1997;29:1074–80.
Ogilvie IM, Newton N, Welner SA, Cowell W, Lip GY. Underuse of oral anticoagulants in atrial fibrillation: a systematic review Am J Med 2010, 123:638-645.
Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA. 1989;262:907-913
Dracup K, Walden JA, Stevenson LW, Brecht ML. Quality of life in patients with advanced heart failure. J Heart Lung Transplant. 1992;11:273-279.
Hawthorne MH, Hixon ME. Functional status, mood disturbance and quality of life in patients with heart failure. ProgCardiovascNurs. 1994;9:22-32.
Krumholz HM, Butler J, Miller J, Vaccarino V, Williams CS, Mendes de Leon CF et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation. 1998;97:958-964.
Riedinger MS, Dracup KA, Brecht ML, Padilla G, Sarna L, Ganz PA: Quality of life in patients with heart failure: Do gender differences exist? Heart Lung 2001;30: 105-116
Meyer K, Laederach-Hofmann K. Effects of a Comprehensive Rehabilitation Program on Quality of Life in Patients With Chronic Heart FailureProgCardiovascNurs. 2003;18:169-176
Rector T, Kubo SH, Cohn JN. Patients' self-assessment of their congestive heart failure. Part 2: content, reliability and validity of a new measure, The Minnesota Living with Heart Failure Questionnaire. Heart Fail. 1987; 3:198-208
Quittan M, Wiesinger GA, Crevenna R. Cross-cultural adaptation of the Minnesota Living With Heart Failure Questionnaire for German-speaking patients. J RehabilMed. 2001;33:182-186
Zuccalà G, Onder G, Marzetti E, Lo Monaco MR, Cesari M, Cocchi A et al. Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. EurHeart J 2005;26: 226-233
Zuccalà G, Marzetti E, Cesari M, Lo Monaco MR, Antonica L, Cocchi A et al. Correlates of cognitive impairment among patients with heart failure: Results of a multicenter survey. Am J Med 2005;118:496-500
HsichEM, Grau-Sepulveda MV, Hernandez AF, Peterson ED, Schwamm LH, Bhatt DL, et al. Sex differences in in-hospital mortality in acute decompensated heart failure with reduced and preservedejection fraction. Am Heart J. 2012;16:430-437.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186