Phenotypic and structural features of heart failure in women

Although one half of patients affected by heart failure (HF) are women, the clinical phenotype differs between genders. In women HF develops later in life, is more often associated with preserved systolic function and is less frequently attributable to ischemic heart disease. Although survival tends to be better in women than in men, females are more symptomatic, have a worse quality of life and a longer length of stay during acute HF admissions. Italian data from institutional databases of the Lazio, Basilicata and Veneto regions are in agreement with international evidences on this topic. Gender differences in clinical phenotypes are based on different structural and functional patterns: the female heart undergoes more often concentric remodeling, with thicker walls, smaller volumes and greater chamber stiffness. There are no specific therapeutic evidences for the elderly, prevalently female, HF population. Treatment strategies are derived from studies carried out in relatively young male populations with left ventricular systolic dysfunction. Therapeutic strategies tailored to the peculiar female HF phenotype should be better explored in future treatment trials.