Dr Amresh Raina Addresses Gender Differences in HF Presentation


Disease symptomatology may be the same, but the presentation of heart failure (HF) and heart attacks differ between women and men, explained Amresh Raina, MD, of the Allegheny Health Network in Pittsburgh, Pennsylvania.

Disease symptomatology may be the same, but presentation of heart failure (HF) and heart attacks differ between women and men; for example, women tend to develop HF with preserved ejection fraction and have more subtle signs of heart attacks, whereas men more often develop HF with reduced ejection fraction and have the classic crushing chest pain, explained Amresh Raina, MD, director of the Advanced Heart Failure and Pulmonary Hypertension Program at Allegheny General Hospital and the Allegheny Health Network in Pittsburgh, Pennsylvania.


Can you discuss any disparities between women and men regarding heart failure care and potential ways we can overcome them?

Patients with congestive heart failure do have similar symptomatology between men and women, but if we look at advanced heart failure, women seem to be less frequently referred for heart transplants or even implantable mechanical heart pumps than men. If you look at patients nationwide, this is a common trend that, for whatever reason, there's a disparity between men and women getting advanced heart failure treatments, like heart transplant or mechanical heart pumps, left ventricular assist devices.

Some of this may be because of a slight difference in the physiology. Women oftentimes will develop what we call heart failure with preserved ejection fraction. This is an entity that occurs in older patients who have high blood pressure, diabetes, chronic kidney disease, and are overweight. And this is when the heart muscle is not weak, but it can become stiff as people age and predisposed to fluid retention and shortness of breath. Whereas more men typically have risk factors for coronary artery disease, what we call ischemic heart disease, developing heart attacks of earlier ages, and they have more frequently weak heart muscle and heart failure with reduced ejection fraction, which is more amenable to mechanical heart pumps and heart transplantation.

However, there's a large overlap in the middle, and I think that part of the disparity that we see between men and women with heart attack care, for example, is that women often present with heart attacks with slightly different symptomatology than men. Men oftentimes will have the classic crushing chest pain, an elephant sitting on their chest, etc, whereas women will have more subtle findings such as abdominal discomfort, or nausea, or sweating and may be slower to have the syndrome of having a heart attack recognized and then develop heart failure because they were more delayed in their presentation.

Those are some of the disparities. And some of the things that we've been doing in the world of cardiology at the American Heart Association, the American College of Cardiology is trying to educate the population in general about some of the disparities between those heart attacks, those ACS [acute coronary syndrome] presentations between men and women and to recognize the fact that coronary artery disease and heart attack and stroke are still one of the leading reasons why women pass away. It's not just a problem for postmenopausal women anymore.

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