Failure of women's hearts.

Recently, differences in the management of men and women with ischemic heart disease have been highlighted.1 Although at least as great, sex differences in heart failure have received little attention. In this article, we review the evidence that men and women with heart failure may differ with respect to epidemiology, etiology, diagnosis, prognosis, and treatment. To date, most studies of the prevalence and incidence of heart failure have identified cases on clinical grounds and, in some instances, with the aid of an ECG and chest radiograph. Thus, the precise type of heart failure (eg, left ventricular systolic dysfunction, or valvular disease) is unclear in most reports. This is important in view of the evidence that left ventricular systolic dysfunction is less common in women than in men with suspected heart failure (see the “Diagnosis” section below). ### Prevalence With these caveats in mind, the major epidemiological surveys of heart failure (see the Figure⇓)2 3 4 5 show that the overall prevalence rate of heart failure is similar in men and women. This balance, however, reflects a much lower female prevalence <70 to 75 years of age and a higher prevalence in older women than in older men. Overall, within the population, there appear to be more women than men with heart failure.6 7 8 Although age-adjusted rates for both sexes have decreased from 1988–1995, rates for women have fallen less than those for men.8B Figure 1. Sex differences in prevalence of heart failure and left ventricular systolic dysfunction in major epidemiological studies. *Based on clinical criteria; **based on echocardiography. ### Incidence Although the absolute incidence rate is lower than the prevalence rate, the effect of age on sex incidence is similar.3 Risk factors for heart failure appear to differ markedly between the sexes. ### Hypertension The risk of heart failure imparted …