Heart Failure With Reduced Ejection Fraction

Heart failure (HF) with reduced ejection fraction (HFrEF), defined as clinical signs and symptoms of volume overload and/or low cardiac output with an ejection fraction (EF) of = ?40%, affects an estimated 3.5 million patients in the United States. Women account for 36% of this population. Studies in the last decade have highlighted differences between women and men with HFrEF involving multiple aspects of the syndrome including epidemiology, pathophysiology, outcomes, and treatment. Women with HFrEF have fewer comorbidities, lower rates of hospitalization, and superior survival compared to men, but they also experience more symptoms, poorer functional status, and worse health-related quality of life (HRQOL). While disparities in the prescription of guideline-directed medical therapy (GDMT) have narrowed somewhat, women are still undertreated with diuretics and devices, and are less likely to be referred to disease management programs. Further, women remain significantly underrepresented in clinical HF trials, limiting available data guiding potential sex-specific clinical approaches. These differences in presentation, outcomes, and treatment are likely secondary to both biological and psychosocial factors. This chapter will outline important sex-specific differences in HFrEF while also addressing gaps in the literature and future directions.