Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction

Jesse F. Veenis, Hans Peter Brunner La Rocca, Gerard C.M. Linssen, Ayten Erol-Yilmaz, Arjen C.B. Pronk, Domien J.M. Engelen, Rob M. Van Tooren, Hetty J.J. Koornstra-Wortel, Rudolf A. De Boer, Peter Van Der Meer, Arno W. Hoes, Jasper J. Brugts*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


Aims: A recent study suggested that women with heart failure and heart failure reduced ejection fraction might hypothetically need lower doses of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (= renin-angiotensin-system inhibitors) and β-blockers than men to achieve the best outcome. We assessed the current medical treatment of heart failure reduced ejection fraction in men and women in a large contemporary cohort and address the hypothetical impact of changing treatment levels in women. 

Methods: This analysis is part of a large contemporary quality of heart failure care project which includes 5320 (64%) men and 3003 (36%) women with heart failure reduced ejection fraction. Detailed information on heart failure therapy prescription and dosage were collected. 

Results: Women less often received renin-angiotensin-system inhibitors (79% vs 83%, p < 0.01), but more often β-blockers (82% vs 79%, p < 0.01) than men. Differences in guideline-recommended target doses between sexes were relatively small. Implementing a hypothetical sex-specific dosing schedule (at 50% of the current recommended dose in the European Society of Cardiology guidelines in women only) would lead to significantly higher levels of women receiving appropriate dosing (β-blocker 87% vs 54%, p < 0.01; renin-angiotensin-system inhibitor 96% vs 75%, p < 0.01). Most interestingly, the total number of women with >100% of the new hypothetical target dose would be 24% for β-blockers and 52% for renin-angiotensin-system inhibitors, which can be considered as relatively overdosed. 

Conclusion: In this large contemporary heart failure registry, there were significant but relatively small differences in drug dose between men and women with heart failure reduced ejection fraction. Implementation of the hypothetical sex-specific target dosing schedule would lead to considerably more women adequately treated. In contrast, we identified a group of women who might have been relatively overdosed with increased risk of side-effects and intolerance.

Original languageEnglish
Pages (from-to)957-965
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number9
Early online date12 May 2021
Publication statusPublished - 1 Sept 2021

Bibliographical note

... for the CHECK-HF invesigators

Publisher Copyright: © 2020 The Author(s).


Dive into the research topics of 'Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction'. Together they form a unique fingerprint.

Cite this