Dissimilarities in Females Having Heart Failure with Mildly Reduced Ejection Fraction
Issue: 2023 - Volume 6 [Issue 1]
C. Hemnath *
DrNB Cardiology, Apollo Hospitals, Chennai, India.
Department of Cardiology, Apollo Hospitals, Chennai, India.
*Author to whom correspondence should be addressed.
Background: The clinical features, epidemiology, pathogenesis & management of heart failure with mildly reduced ejection fraction (HFmrEF) differ in gender-specific dissimilarities like hormonal impact, anthropometry, pregnancy-related changes, comorbidities, specific diseases in women (incidence of HFpEFis higher in females whereas HFrEF is more common in males). This study aims to identify gender differences with meaningful clinical implications in females diagnosed with heart failure with HFmrEF.
Methodology: This study was done in 130 patients with HFmrEF patients aged more than 18 years without any evidence of sepsis were included in this study.
Results: Females patients were 26% (35 patients) of the study population having mean age of 64 years and belonged to upper-middle SES. Mean BMI was 25.6 (class I obesity), NYHA class II & III noted in 58% & 37% respectively. CAD was seen in 57%,mean haemoglobin & NT-proBNP were 10.8 gm% & 11145pg/ml respectively. Patients had mean EF of 44% and moderate PH was noted in 35%. Readmission rates were 28% in 1 year (17% in males). Around 90 % were on anti-platelets, statins and beta-blocker therapy. Diuretics/MRA’s were used in <40% (compared to 31% in males), while SGLT2I & ARNI used in 30% & 16% respectively (42% & 20 % males). An improvement in left ventricular function was noted in 30% and AKI, CKD, ADHF & UTI were the major deterrents for initiating core HF therapy.
Conclusion: This study addressed the under-represented female population with HFmrEF sharing similar clinical features as their gender counterparts but with a higher proportional prevalence of anaemia, PH, CKD, readmission rates, and inadequate core HF treatment.
Keywords: Heart failure, ejection fraction, phenotypes, gender differences
How to Cite
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation. 2016;133(16):1605–20.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200
Savarese G, Lund LH. Global public health burden of heart failure. Cardiac Failure Review. 2017;3(1):7.
Harikrishnan S, Sanjay G, Anees T, Viswanathan S, Vijayaraghavan G, Bahuleyan CG, et.al. Clinical presentation, management, in‐hospital and 90‐day outcomes of heart failure patients in Trivandrum, Kerala, India: The Trivandrum Heart Failure Registry. European journal of heart failure. 2015;17(8):794-800.
Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Nanjappa MC, et al. National Heart Failure Registry, India: Design and methods. Indian Heart J. 2019;71(6):488–91.
Bhambhani V, Kizer JR, Lima JAC, van der Harst P, Bahrami H, Nayor M, et al. Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail. 2018;20(4):651–9.
Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews Cardiology. 2022 Feb;19(2): 100-16.
Catchpool M, Ramchand J, Hare DL, Martyn M, Goranitis I. Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) onto the Assessment of Quality of Life 8D (AQoL-8D) utility scores. Qual Life Res. 2020;29(10):2815–22.
Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. The Lancet. 2018;391(10120):572–80
Sakata Y, Shimokawa H. Epidemiology of heart failure in Asia. Circ J. 2013; 77(9):2209–17.
Crespo‐Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, Ferrari R, et al. European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions. European journal of heart failure. 2016; 18(6):613-25.
Savarese G, Kishi T, Vardeny O, AdamssonEryd S, Bodegård J, Lund LH, et al. Heart failure drug treatment—inertia, titration, and discontinuation: a multinational observational study (EVOLUTION HF). Heart Failure. 2023;11 (1):1-4.
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GM, Coats AJ. Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research. 2022 1;118(17): 3272-87.
Miller RJH, Nabipoor M, Youngson E, et al. Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk. ESC Heart Fail. 2022;9(3):1564-1573. DOI:10.1002/ehf2.13869
Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ, et al. Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J. 2014;168(5):721–30.
Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: A systematic review and meta-analysis. ESC Heart Fail. 2018;5(4):685–94.