Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Curr Heart Fail Rep. 2021 Oct;18(5):284-289. doi: 10.1007/s11897-021-00524-z. Epub 2021 Jul 2.
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.
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.
本综述综合了女性射血分数降低心力衰竭(HFrEF)患者接受指南指导的药物治疗(GDMT)的性别差异和反应,讨论了 HFrEF 临床试验中女性的代表性,并概述了未来减少全球 HFrEF 护理中性别差异的研究领域。
观察性登记研究表明,GDMT 率仍存在性别特异性差异,HFrEF 患者 GDMT 的最佳剂量可能存在关键的性别特异性差异。HF 临床试验中女性患者代表性不足是一个关键障碍,HF 临床试验领导层的性别差异可能会影响 HFrEF 患者医学管理的性别特异性知识生成。女性 HFrEF 患者在 GDMT 使用和反应方面存在重要的性别特异性差异,需要进一步研究。增加 HFrEF 临床试验中女性的代表性,使 HF 试验领导层多样化,并在从概念到报告的研究生命周期中嵌入性别特异性方法,对于减少所有 HFrEF 患者临床护理中的性别差异至关重要。