Anubha Agarwal1, Sanne A E Peters2,3,4, Chanchal Chandramouli5, Carolyn S P Lam5,6, Gemma A Figtree7, Clare Arnott4,8. 1. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. anubha.agarwal@northwestern.edu. 2. George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK. 3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 4. George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 5. National Heart Centre Singapore, Singapore, Singapore. 6. Duke University-National University of Singapore Graduate Medical School, Singapore, Singapore. 7. Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia. 8. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Abstract
PURPOSE OF REVIEW: This narrative review synthesizes sex differences in guideline-directed medical therapy (GDMT) use and response among female patients with heart failure with reduced ejection fraction (HFrEF), discusses female representation in HFrEF clinical trials, and outlines future areas of investigation to reduce sex disparities in HFrEF care globally. RECENT FINDINGS: Observational registries suggest sex-specific disparities persist in GDMT rates, and there may be key sex-specific differences in optimal dosing of GDMT in HFrEF patients. Underrepresentation of female patients in HF clinical trials is a key barrier, and sex disparities in HF clinical trial leadership may influence sex-specific knowledge generation of medical management of HFrEF patients. There are important sex-specific differences in GDMT use and response among female HFrEF patients that warrant further study. Increasing female representation in HFrEF clinical trials, diversifying HF trial leadership, and embedding sex-specific approaches in the lifecycle of research from conception to reporting are essential to decreasing sex disparities in clinical care of all HFrEF patients.
PURPOSE OF REVIEW: This narrative review synthesizes sex differences in guideline-directed medical therapy (GDMT) use and response among female patients with heart failure with reduced ejection fraction (HFrEF), discusses female representation in HFrEF clinical trials, and outlines future areas of investigation to reduce sex disparities in HFrEF care globally. RECENT FINDINGS: Observational registries suggest sex-specific disparities persist in GDMT rates, and there may be key sex-specific differences in optimal dosing of GDMT in HFrEF patients. Underrepresentation of female patients in HF clinical trials is a key barrier, and sex disparities in HF clinical trial leadership may influence sex-specific knowledge generation of medical management of HFrEF patients. There are important sex-specific differences in GDMT use and response among female HFrEF patients that warrant further study. Increasing female representation in HFrEF clinical trials, diversifying HF trial leadership, and embedding sex-specific approaches in the lifecycle of research from conception to reporting are essential to decreasing sex disparities in clinical care of all HFrEF patients.
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