Missing: Adequate data on CHF in women
Missing: Adequate data on CHF in women
After searching through the literature, comparing the CHF findings between men and women, a Scottish team not only mapped out differences between the sexes, but notes there are dramatic unknowns that need to be studied — if researchers are interested enough to pursue them.
"I’m sure women have been neglected, but we do not know why," says John J.V. McMurray, MD, FRCP, FESC, from the Medical Research Council Clinical Research Initiative in Heart Failure in Glasgow. McMurray responded to questions from CHF Disease Management through e-mail.
"Do they not get referred to a hospital? Are they not asked to participate in trials? Do they refuse to participate in trials? Do upper-age limits or exclusion comorbidities disproportionately exclude women from trials?" McMurray speculates. "We simply don’t know but should!"
McMurray and the rest of the team found numerous differences in CHF in women. Here are just a few highlights:
1. Among patients suspected of CHF, left- ventricular systolic dysfunction is not as common in women.
2. The numbers of CHF patients are about equal between the sexes, but women are older.
3. Women have distinct differences in CHF risk; more go on to develop it once they have hypertension.
4. While women are not as likely to get coronary artery disease compared to men, when they do develop it, more go on to CHF than men. In black CHF patients, more females have coronary artery disease than men.
5. Women are more likely than men to develop CHF after coronary bypass graft.
6. Of CHF patients, women are more likely to be diabetic and exhibit their own type of cardiomyopathy and left-ventricular wall mass.
7. For treatment, women are more likely to be treated by generalists. They are less likely to be referred to a hospital. When they are hospitalized, women are less likely to go to a teaching hospital and are less likely to be managed by a cardiologist.
8. Women with CHF appear to have lower quality of life and exercise performance.
"We basically compared men and women in all published reports concerning (1) heart failure — with no determination of left-ventricular systolic function and (2) heart failure, where, by definition, all patients had a low LVEF," says McMurray.
Also, the team asked what could be wrong with women who don’t seem to have left-ventricular systolic dysfunction, yet lead their doctors to believe they have heart failure.
McMurray says he suspects obesity is "almost certainly an issue," and that "there may well be a different female heart failure’ syndrome where diastolic function’ or something else we haven’t thought of is important."
Suggested reading
1. Adams KF, et al. Gender differences in survival in advanced heart failure. Circulation 1999; 14:1,816.
2. Petrie, et al. Failure of women’s hearts. Circulation 1999; (17):2,334.
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