Heart failure & cardiomyopathiesCohort study
Differences between men and women in guideline-directed medical therapy implementation, tolerability, and outcomes in heart failure with reduced ejection fraction
- prospective registry
- 48 Dutch hospitals
- inclusion June 2022-February 2024
Authors' conclusion
Guideline-directed medical therapy initiation and sequencing were comparable between men and women, but differences were observed in dose achievement, treatment tolerability, and clinical outcomes. These findings underscore the need for implementation and dosing strategies that account for differences between men and women.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) (de novo, chronic, and worsening heart failure)men 2,408 · women 959
- Participants
- 3,367 HFrEF patients
- Exposure
- compared men and women regarding guideline-directed medical therapy (GDMT) implementation, side effects, change in left ventricular ejection fraction (LVEF), and clinical outcomes
- menn = 2,408reference
- womenn = 959
Main finding
As reported in the abstract
Quadruple therapy · 12-month follow-up
P = 0.729
Observational data: associations, not effects.
Further findings
Quadruple therapy at ≥50% of target doses · Men more often achieved
P = 0.004
LVEF improvement in de novo HFrEF · women showed greater LVEF improvement
P = 0.005
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Composite endpoint (first HF hospitalization or all-cause death) in chronic HFrEF · lower risk in women | 0.64 (0.45–0.91) | P = 0.015 | |
| 0.512Adjusted hazard ratio (log scale) |
Safety
Downgrades due to side effects
ARB
MRA
- Downgrades due to side effects: ARB P = 0.040
- Downgrades due to side effects: MRA P = 0.038
Original publication
Differences between men and women in guideline-directed medical therapy implementation, tolerability, and outcomes in heart failure with reduced ejection fraction. Eur Heart J Qual Care Clin Outcomes. Published 25 July 2026. doi:10.1093/ehjqcco/qcag116
Summarised from the published abstract; every number is checked against it