Sex differences and atrial fibrillation in heart failure with reduced versus preserved ejection fraction

Heart failure is a major public health problem. Patients with heart failure often experience dyspnoea, fatigue and/or have peripheral oedema. The prognosis of heart failure remains poor, with a severely impaired quality of life, frequent hospitalizations and a five-year mortality rate around 50%. The two most prevalent forms of heart failure are heart failure with a reduced ejection fraction and heart failure with a preserved ejection fraction. Several medical treatments have greatly improved clinical outcomes in heart failure with a reduced ejection fraction, but these therapies have unfortunately not been proven effective in patients with heart failure with a preserved ejection fraction. Atrial fibrillation is the most common arrhythmia in heart failure, with a prevalence between 25-65% depending on the type and severity of heart failure. Important differences have been observed between men and women with heart failure and atrial fibrillation, yet poorly understood. The aim of this thesis was to examine the complex pathophysiological interplay between men and women with atrial fibrillation and heart failure with reduced versus preserved ejection fraction, which will ultimately lead to better treatments. The thesis describes that the optimal doses of heart failure medication for women appeared lower than in men (around 50% of the doses that are currently recommended), which could have important clinical implications. Another study revealed profound differences in biomarkers profiles in patients with atrial fibrillation and heart failure with a reduced ejection fraction as compared to those with a preserved ejection fraction.