Chronic heart failure
² Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini Hospital, Rome, Italy – Fondazione per il Tuo cuore – Heart Care Foundation, Firenze, Italy
³ Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
⁴ Dipartimento di Area Medica, ASST Sette Laghi, Varese, Italy. Associate professor of Internal Medicine, Insubria University, Varese. Presidente FADOI Nazionale
⁵ Societa Italiana di Medicina Generale e delle Cure Primarie – SIMG, Firenze
Abstract
The paper provides a comprehensive overview of chronic heart failure (CHF), focusing on sex and gender differences in epidemiology, clinical phenotypes, risk factors, diagnosis, therapeutic response, and prognosis. CHF affects both men and women, with notable differences in underlying mechanisms, clinical presentation, disease progression, and treatment response. Women are more likely to develop heart failure with preserved ejection fraction (HFpEF), often associated with diastolic dysfunction and endothelial impairment, while ischemic etiology and heart failure with reduced ejection fraction (HFrEF) are less frequent. Traditional risk factors such as hypertension, diabetes, and obesity impact women differently, with hypertension and diabetes conferring a higher relative risk for heart failure in women compared to men. Certain specific or prevalent risk factors in women, such as peripartum cardiomyopathy, exposure to cardiotoxic therapies for cancer, and autoimmune diseases, further contribute to the burden of disease. Diagnostic approaches and biomarker interpretation require consideration of anatomical and physiological sex differences. Women tend to have higher levels of natriuretic peptides and lower troponin values, reflecting distinct pathophysiological processes. Pharmacological therapy is complicated by differences in pharmacokinetics and pharmacodynamics, with women often responding to lower drug doses but experiencing more adverse effects. Access to advanced therapies and devices remains limited for women, who also face higher complication rates and longer waiting times for interventions such as LVAD implantation and heart transplantation. Despite a generally better prognosis in terms of mortality and sudden death, women with CHF experience poorer quality of life, greater physical disability, and higher rates of anxiety and depression. The chapter highlights the need for personalized, multidisciplinary management strategies that account for sex and gender differences to optimize clinical outcomes and equity in care.
Key words: Women; Chronic Heart Failure; Sex and Gender Differences; HFPEF; Biomarkers; Device Therapy.
