While discussing heart failure in women, Deborah L. Crabbe, MD, Temple University Hospital, Philadelphia, PA, pointed to a small but intriguing number of studies that suggested that the pathophysiology of heart failure is different in women than it is in men. These include the fact that women often have higher left ventricular ejection fractions (LVEFs) [Bhatia RS et al. N Engl J Med 2006; Owan TE et al. N Engl J Med 2006] and more hypertrophy [Kostkiewicz M et al. Int J Cardiol 1999], and are more likely to have dyspnea and edema [Johnstone D et al. J Cardiol 1992]. Women also have a lower risk of death irrespective of the cause of their heart failure [O'Meara E et al. Circulation 2007], stated Monica M. Colvin-Adams, MD, University of Minnesota, Minneapolis, MN.

JoAnn Lindenfeld, MD, University of Colorado, Denver, CO, noted that there are several gender differences that impact therapy and adverse events in women, including creatinine clearance, lean body mass, metabolism, thrombogenicity, sex hormones, and QT prolongation. She also pointed out that, although women appear to benefit more from angiotensin receptor blockers than men, the relatively small number of women that has been studied limits the interpretation of these data [Ghali JK & Linderfeld J. Expert Rev Cardiovasc Ther 2008].

Cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy are known to improve survival in patients with heart failure. Jamie B. Conti, MD, Shands Hospital University of Florida, Gainesville, FL, presented data showing that women, however, are significantly less likely than men to receive ICDs and are often underrepresented in device-based efficacy and safety clinical trials. Although the American College of Cardiology/American Heart Association guidelines recommend equal treatment for men and women, women also suffer from bias that results in lower referral rates.

Patricia P. Chang, MD, University of North Carolina, Chapel Hill, NC, spoke about gender disparity in heart transplants. Approximately 25% of recipients are females, while 31% of donors are females. This disparity may be related to women's lower body mass index, which places physical limits on the use of ventricular assist devices (VAD) as a treatment option. Ineligibility for VAD decreases the United Network for Organ Sharing medical urgency status, thus reducing the chance for timely transplantation.