SINGAPORE – Women have smaller hearts than men and therefore experience different outcomes when receiving treatment for heart failure. However, doctors here continue to use the same criteria for diagnosing and treating both groups, resulting in less effective treatment for women.

Therefore, guidelines on how women with heart failure are diagnosed and treated need to change, said Professor Carolyn Lam, director of women’s heart health at the National Heart Center Singapore (NHCS).

Her research over the past decade has found that male and female patients respond differently to medical and mechanical treatments for heart failure and cardiac rehabilitation, and have different treatment outcomes.

“We no longer simply describe women with heart failure as older, thinner, smaller, and more symptomatic. There really is a difference,” said Professor Lam, who is also a senior consultant in the Department of Cardiology at NHCS.

She notes that while biological differences in the epidemiology, risk factors, clinical features, and outcomes of heart failure are well known, research over the past decade has shown that “an often overlooked aspect of heart failure is the influence of gender on treatment response. “We have just shed light on this,” he said. ”.

Although there are similarities in how men and women respond to heart failure treatments, “the differences lie in treatment efficacy, dose response, and tolerability to pharmacotherapy, mechanical therapy, and cardiac rehabilitation,” he noted.

Professor Lam gave the example of cardiac resynchronization therapy, a treatment that uses a pacemaker to help the heart beat at the correct rhythm.

“We found that when we apply the same criteria to women’s hearts and give them the same treatments (as men do), women’s hearts elicit a much greater response. By nature, women’s hearts are smaller. “By the time you define an abnormality by applying the same guidelines as for larger men, it will already be very serious for women,” she says.

Also, because women have more body fat, different drug treatments have different effects.

“The same dose can be much more toxic in women than in men,” she added.

“So why do we keep using the same standards that are always right for men and not for women? That’s the main reason why things are so confusing,” she said. .

“We need to define guidelines according to what is normal for women and what is normal for men.”

Professor Lam also pointed out bias in the research.

“Women are underrepresented in international studies, especially in all cardiac clinical trials, and even when women are included, aggregate results are not taken into account at all,” she said.

She noted that this male bias is present in all areas of preclinical research.