Sex Differences in the Diagnosis and Management of Heart Failure Among Outpatients with Type 2 Diabetes

Abstract

Background:

Heart failure (HF) and type 2 diabetes (T2D) frequently coexist and contribute to adverse outcomes. We aimed to explore sex-related differences in HF presentation and outcomes in a nationwide cohort of T2D outpatients.

Materials and Methods:

We analyzed a prospective cohort of 1,249 T2D outpatients recruited from cardiology and endocrinology clinics across 30 Spanish centers. HF was classified according to left ventricular ejection fraction (LVEF) into reduced (HFrEF; LVEF <40%), mid-range (HFmrEF; LVEF 40–49%), and preserved ejection fraction (HFpEF; LVEF ≥50%). Sex-related differences in HF characteristics, treatment, and 3-year clinical outcomes were assessed.

Results:

HF prevalence did not differ significantly between women and men (initial visit: 37.2% versus 40.4%, p = 0.285; 3-year visit: 45.9% versus 51.7%, p = 0.294). However, HFpEF predominated among women and HFrEF among men (p < 0.001). HF was associated with increased mortality (odds ratio 4.26; 95% confidence interval, 2.65–7.04; p < 0.001), with no interaction by sex (p for interaction = 0.326). Women with HFrEF were less likely to receive angiotensin receptor–neprilysin inhibitors (44.2% versus 62.9%, p = 0.035). Among HFpEF patients, women were more frequently treated with diuretics (82.4% vs 66.5%, p = 0.009).

Conclusion:

Despite similar prevalence and prognosis, women were more likely to present with HFpEF and were less likely to receive optimal guideline-directed therapies, underscoring sex-based differences in both the presentation and management of HF.