Sex differences: implications for heart failure care

See doi:10.1016/j.ehj.2003.10.003for the article to which this editorial refers There is a strong interest in differences in the care and outcomes between men and women with cardiovascular disease. In the United States, for example, the Institute of Medicine and Agency for Healthcare Research and Quality have specifically emphasized the need to address disparities in care in order to optimize population health.1Heart failure has been identified as an important condition in which to evaluate sex differences because of high prevalence, significant morbidity and mortality, and because women constitute the majority of patients with heart failure.2To date, however, research on sex differences in heart failure has had a limited impact on practice. Inconsistent findings in the literature have left clinicians confused about the implications for clinical care. A majority of previous studies have found that men with heart failure have worse survival than women, but other studies have been neutral and at least one study suggested that women are at higher risk.3–5At the same time, most studies have suggested that women receive fewer guideline-indicated heart failure therapies, but studies are again mixed.5,6The inconsistency of study results has been attributed, at least in part, to methodological limitations including non-representative populations, inadequate clinical data for risk adjustment, and limited follow-up. Ultimately, it is difficult to draw firm conclusions from the literature about the magnitude and direction of … *Corresponding author: John S. Rumsfeld MD PhD FACC, Assistant Professor of Medicine, University of Colorado Health Sciences Center, Cardiology (111B), Denver VA Medical Center, 1055 Clermont St., Denver, CO 80220 USA. Tel.: +1-303-399-8020 x2131; Fax: +1-303-393-5054
 E-mail address: John.Rumsfeld{at}med.va.gov