Heart failure is a serious, potentially life-threatening condition. There is ongoing debate as to whether or not people with systolic heart failure have a worse chance of surviving than people with diastolic heart failure, with more recent studies indicating that both forms of heart failure are equally serious and have similar prognosis.28-30 However, it is clear that women with systolic heart failure have a better survival than men.9, 11, 12, 15, 31, 32
Women's better survival with systolic heart failure may be due to the common causes of blood-pumping problems in women. Systolic heart failure caused by CAD and heart attack has a worse outcome than systolic heart failure resulting from other conditions such as high blood pressure or diabetes, which are more common causes in women. About 40% of systolic heart failure in women is caused by CAD or heart attack, and 60% is due to other causes.15 However, when women develop systolic heart failure as a result of CAD or heart attack, they may have a higher risk of dying, even when compared with men.33
Other studies suggest that more women survive systolic heart failure because women are more likely than men to have better blood-pumping function, or higher ejection fraction.1, 9 One study of 2708 adults (22% were women) with systolic heart failure found that for every 1% increase in ejection fraction in women, there was a 4% decrease in the risk of death; men had a 1% decrease for every 1% increase in ejection fraction.12
- 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. June 1, 1999;33(7):1948-1955.
- Ilksoy N, Hoffman M, Moore RH, Easley K, Jacobson T. Comparison of African-American Patients With Systolic Heart Failure Versus Preserved Ejection Fraction. Am J Cardiol. Sept 15 2006;98(6):806-808.
- Kitzman DW, Little WC, Brubaker PH, et al. Pathophysiological Characterization of Isolated Diastolic Heart Failure in Comparison to Systolic Heart Failure. JAMA. November 6, 2002;288(17):2144-2150.
- Chung AK, Das SR, Leonard D, et al. Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular Volume: The Dallas Heart Study. Circulation. March 28, 2006;113(12):1597-1604.
- Krumholz HM, Larson M, Levy D. Sex differences in cardiac adaptation to isolated systolic hypertension. Am J Cardiol. Aug 1 1993;72(3):310-313.
- Mendes LA, Davidoff R, Cupples LA, Ryan TJ, Jacobs AK. Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J. Aug 1997;134(2 Pt 1):207-212.
- Carroll JD, Carroll EP, Feldman T, et al. Sex-associated differences in left ventricular function in aortic stenosis of the elderly. Circulation. October 1, 1992;86(4):1099-1107.
- Tandon S, Hankins SR, Le Jemtel TH. Clinical Profile of Chronic Heart Failure in Elderly Women. Am J Geriatr Cardiol. 2002;11(5):318-325.
- Alla F, Al-Hindi AY, Lee CR, Schwartz TA, Patterson JH, Adams KF. Relation of sex to morbidity and mortality in patients with heart failure and reduced or preserved left ventricular ejection fraction. Am Heart J. June 2007;153(6):1074-1080.
- Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. January 15, 2003;41(2):217-223.
- O'Meara E, Clayton T, McEntegart MB, 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. June 19, 2007;115(24):3111-3120.
- Ghali JK, Krause-Steinrauf HJ, Adams KF, et al. Gender differences in advanced heart failure: insights from the BEST study. J Am Coll Cardiol. Dec 17 2003;42(12):2128-2134.
- Johnstone D, Limacher M, Rousseau M, et al. Clinical characteristics of patients in studies of left ventricular dysfunction (SOLVD). Am J Cardiol. Oct 1 1992;70(9):894-900.
- Lund LH, Mancini D. Heart failure in women. Med Clin North Am. Sep 2004;88(5):1321-1345, xii.
- Frazier CG, Alexander KP, Newby LK, 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. April 3, 2007;49(13):1450-1458.
- Petrie MC, Dawson NF, Murdoch DR, Davie AP, McMurray JJV. Failure of Women's Hearts. Circulation. May 4, 1999;99(17):2334-2341.
- Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. May 22-29 1996;275(20):1557-1562.
- Pina IL. A better survival for women with heart failure? it's not so simple. J Am Coll Cardiol. December 17, 2003;42(12):2135-2138.
- 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. Apr 2 2002;105(13):1585-1591.
- Boudina S, Abel ED. Diabetic Cardiomyopathy Revisited. Circulation. June 26, 2007;115(25):3213-3223.
- Taegtmeyer H, McNulty P, Young ME. Adaptation and Maladaptation of the Heart in Diabetes: Part I: General Concepts. Circulation. April 9, 2002;105(14):1727-1733.
- Natarajan S, Liao Y, Cao G, Lipsitz SR, McGee DL. Sex Differences in Risk for Coronary Heart Disease Mortality Associated With Diabetes and Established Coronary Heart Disease. Arch Intern Med. July 28, 2003;163(14):1735-1740.
- Zile MR, Brutsaert DL. New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function. Circulation. March 19, 2002;105(11):1387-1393.
- Hunt SA. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. September 20, 2005;46(6):e1-82.
- Mezu U, Bott-Silverman C, Hsich E. Heart failure in women is different than in men; should treatment be different? Cleve Clin J Med. Jun 2007;74(6):423-424, 426, 429-435.
- Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA. May 10, 1995;273(18):1450-1456.
- Shekelle PG, Rich MW, Morton SC, et al. Efficacy of angiotensin-converting 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 Am Coll Cardiol. May 7 2003;41(9):1529-1538.
- Bursi F, Weston SA, Redfield MM, et al. Systolic and Diastolic Heart Failure in the Community. JAMA. November 8, 2006;296(18):2209-2216.
- Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. N Engl J Med. July 20, 2006;355(3):251-259.
- Tribouilloy C, Rusinaru D, Mahjoub H, et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J. February 1, 2008;29(3):339-347.
- Adams KF, Jr., Sueta CA, Gheorghiade M, et al. Gender Differences in Survival in Advanced Heart Failure : Insights From the FIRST Study. Circulation. April 13, 1999;99(14):1816-1821.
- 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. January 23, 2001;103(3):375-380.
- Hsich E, Chadalavada C, Krishnaswamy G, et al. Long-Term Prognostic Value of Peak Oxygen Consumption in Women Versus Men With Heart Failure and Severely Impaired Left Ventricular Systolic Function. Am J Cardiol. July 15, 2007;100(2):291-295.