Cardiovascular medicine has long operated under the assumption that heart failure affects men and women similarly once diagnosed. New evidence from nearly 1,000 elderly patients challenges this paradigm, revealing that biological sex fundamentally alters both disease presentation and prognosis in heart failure with preserved or mildly reduced pumping capacity—conditions that predominantly affect older adults and represent the fastest-growing segment of heart failure cases.
The Italian research tracked patients over 65 years old with these specific heart failure subtypes, finding that men experienced composite adverse outcomes at a rate of 20.6 events per 100 patient-years compared to 17.1 in women. After controlling for multiple variables, male sex emerged as an independent predictor carrying a 40% increased hazard ratio for death, emergency hospitalization, or urgent transplant need. Men also presented with significantly higher rates of diabetes, obesity, and coronary artery disease—a clustering that suggests different underlying pathophysiology.
This sex-based disparity represents more than statistical noise in a condition affecting millions of aging adults globally. The preserved ejection fraction variant particularly impacts women, yet paradoxically, men with this supposedly "milder" form face worse outcomes. The finding contradicts earlier assumptions about gender-neutral prognosis once ejection fraction is preserved. Swedish registry validation strengthens confidence in these patterns. For clinicians managing older heart failure patients, these results suggest risk stratification models should incorporate biological sex as a primary variable, potentially leading to more aggressive monitoring and earlier intervention in male patients despite similar ejection fraction measurements.