Cor Vasa 2025, 67(4):437-442 | DOI: 10.33678/cor.2025.082

Sex-Based Differences in Heart Failure: A Retrospective Analysis of Clinical Management and Outcomes in a Portuguese Cardiology Department

Ana Rodrigo Costa, José Luís Ferraro, Mauro Moreira, Joel Ponte Monteiro, Joana Correia, Liliana Reis, Aurora Andrade

Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal

Aim: Understand sex-specific differences in heart failure (HF) with a focus on their implications for clinical management strategies and patient outcomes.

Methods: This retrospective single-center observational cohort study included all patients admitted with a diagnosis of heart failure to a Portuguese cardiology department during the year of 2022. Patients were divided into two groups based on sex. The primary endpoint was a composite of cardiovascular mortality, all-cause mortality, HF hospitalization, oral diuretic up-titration, and unplanned visits for intravenous diuretic therapy. Secondary outcomes included the prescription of complete guideline-directed medical therapy (GDMT) at discharge and changes in left ventricular ejection fraction (LVEF) one-year post-discharge.

Results: A total of 265 patients were included, 68% male and 32% female, with a median age of 70 ± 12 years. De novo HF was more prevalent in male patients, while female patients showed a higher percentage of admissions for acute decompensated chronic HF (p = 0.009). Regarding HF etiology, ischemic etiology was the number one cause in male patients whereas valvular etiology was more prevalent in female patients (p <0.001). Almost half of female patients (46.3%) had HF with preserved ejection fraction. Only 13.3% of male patients fell into this category, with the vast majority (76.1%) presenting with reduced ejection fraction at the time of admission. At discharge, compared with male patients, female patients were less frequently treated with all four pharmacological pillars for HF (p = 0.041). Female sex was also associated with worsening of left ventricular ejection fraction (LVEF) after one year of hospital discharge (p = 0.03). The combined endpoint was not significantly different between men and women (p = 0.588).

Conclusions: This study highlights that sex-related differences in HF, particularly in terms of presentation, etiology, and response to therapy, are real and warrant greater attention in clinical practice. Although no significant disparities were observed in the composite primary outcome, female patients were less likely to receive complete GDMT and more frequently experienced worsening of LVEF over time. Moving forward, it is crucial to bridge disparities in treatment strategies and ensure equitable care for both men and women in heart failure management.

Keywords: Comorbidities, Guideline-directed medical therapy, Heart failure, Left ventricular ejection fraction, Sex difference

Received: May 3, 2025; Revised: June 25, 2025; Accepted: July 8, 2025; Prepublished online: June 2, 2012; Published: October 6, 2025  Show citation