Why Do Women With Heart Failure Have Poorer Quality of Life?

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Studies have shown that, despite receiving optimal therapy, women are more likely than men to have symptoms of heart failure and to have poorer quality of life (QoL)—even though research has also found that they may survive longer.

In the CHARM study, for instance, which compared outcomes in 2,400 women and 5,199 men, found that while women had progressively increasing symptoms, such as dyspnea and more severe peripheral edema, they had better outcomes than men, irrespective of the cause of heart failure.

Liu Jingxuan and colleagues from Capital Medical University, Beijing, say they also found that women with heart failure have poorer QoL than men do.

In itself, this isn’t news, but these researchers suggest that the disparity might not lie in gender but in other underlying factors that differ between the sexes.

The researchers used the Minnesota Living with Heart Failure Questionnaire to record QoL in 4,082 Chinese patients with heart failure. The patients were followed up over 12 months in the Heart Failure Registry of Patient Outcomes, a prospective, longitudinal, seasonally rotating multicenter study of patients with heart failure from 73 hospitals in Henan, China.

At baseline, the mean MLHFQ was 42.9 ± 19.57. The scores for physical and emotional domains were 22.0 ± 8.69 and 8.66 ± 6.08, respectively.

At 12 months, 19.6% of the patients had died, and 24.4% were hospitalized. The composite end point was 40.15%. A 10-point increase in MLHFQ score was associated with higher risk of mortality (similar for both men and women). The association between health-related quality of life (which in many studies has independently predicted all-cause mortality in heart failure) and hospitalization was not significant among women.

Notably, the researchers said women in the cohort were generally older and had poorer heart function and higher NT-proBNP levels. Women also tended to seek medical care later than men did. However, a significant difference in QoL remained. Factors including lower levels of education and being divorced or widowed were all strong independent predictors of QoL.

Among the limitations the researchers note, the study was retrospective; information was not available on unmeasured confounding variables, such as the patient’s mental state, and psychological factors such as anxiety, depression, and cognitive impairment, all known to be important factors affecting QoL.

Quality of life has the potential to serve as a powerful predictor of clinical prognosis in heart failure, the researchers say, but they also suggest that patient QoL is not regularly evaluated during admission assessments in clinical practice. “Clinically, paying greater attention to the personal and social status of female patient groups, rather than focusing on the sex factor itself may be key to improving QoL.”