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Fewer Women Included in Heart Failure Studies

By Kathy Hubbard

All things being equal, women have as much a chance as men to suffer from heart failure. However, women are less apt to be included in research studies. An article published on the Cleveland Clinic’s website says that although women account for half of the hospital admissions, only 25 percent are involved in heart failure studies.

“Consequently, advances in heart failure therapies apply to most men, but have not been adequately studied in women,” they report.

The National Institutes of Health agrees. In an article published in 2017, they say, “Overall, women are generally underrepresented in clinical trials for heart failure. Further studies are needed to shed light on different mechanisms, causes, and targeted therapies for heart failure in women. To date, there are no prospective HF studies dedicated only to women with HF. Until prospective trial data prove otherwise, HF treatment guidelines should be uniformly applied to both women and men.”

Before we go on, let’s remember that heart failure, often called congestive heart failure, occurs when the heart muscle doesn’t pump blood as well as it should. Symptoms include shortness of breath, fatigue, weakness, swelling in the legs, ankles, feet, rapid or irregular heartbeat, and an inability to exercise. Women and men may not share the same symptoms or have them occur at the same life stages.

Cleveland Clinic says that women tend to develop congestive heart failure at an older age than men. The causes of heart failure in women are often linked to high blood pressure, coronary artery disease, valvular disease, and diabetes mellitus. Depression is often associated with HF, and depression is more common in women than men.

“Although rare, peripartum cardiomyopathy is a cause of heart failure unique to women. PC is the rare development of heart failure within the last month of pregnancy or five months after delivery. Peripartum cardiomyopathy occurs without an identifiable cause,” Cleveland Clinic explains.

“Women tend to develop diastolic heart failure with a more normal ejection fraction than men. Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart,” Cleveland says. “Heart failure can occur due to a weakened heart muscle (systolic heart failure) or may be related to a stiff inflexible heart muscle (diastolic heart failure). In some cases, the ejection fraction can be normal, but due to the increased pressures inside the heart and lungs, the patient can have heart failure.”

The signs and symptoms that also include a persistent cough, increased need to urinate at night, swelling of the abdomen, rapid weight gain from fluid retention, lack of appetite and nausea, difficulty concentrating, or decreased alertness can occur in both men and women. But women tend to have more symptoms, particularly shortness of breath, and more difficulty exercising.

“In general, women survive longer than men with heart failure,” Cleveland says.

NIH says that although survival after an HF diagnosis has significantly improved, the death rate remains high. They estimate that 50 percent of people diagnosed with HF will die within five years.

Diagnostic testing is the same for women as for men. The diagnosis may include evaluating medical history and a physical examination, blood tests, chest x-ray, echocardiogram, electrocardiogram, ejection fraction tests, etc.

Your PCP will want to know about any other conditions you have, such as diabetes, kidney disease, angina, high blood pressure, or other heart problems. You’ll have to self-report if you smoke and if you drink alcohol, and, if so, how much and what medications you take.

Besides some lifestyle changes, heart failure is typically treated with medications. In some cases, surgery is recommended to treat the underlying problem that led to heart failure.

“Guideline-directed medical therapies show no differences in the overall recommendations for standard medical therapy approaches between men and women,” NIH says. But if I’m reading their report correctly, some medications’ efficacy differs between men and women.

I couldn’t find an explanation or even conjecture on why fewer women are included in heart failure research studies. But, I’m heartened to know that esteemed organizations such as NIH and Cleveland Clinic are aware that more women should be included.

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.



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