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

E.F. Veenis, H.P. Brunner-La Rocca, G.C.M. Linssen, A. Erol-Yilmaz, A.C.B. Pronk, D.J.M. Engelen, R.M. van Tooren, H.J.J. Koornstra-Wortel, R.A. de Boer, P. van der Meer, A.W. Hoes, J.J. Brugts*, CHECK-HF Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


AimsA 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 beta-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.MethodsThis 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.ResultsWomen less often received renin-angiotensin-system inhibitors (79% vs 83%, p < 0.01), but more often beta-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 (beta-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 beta-blockers and 52% for renin-angiotensin-system inhibitors, which can be considered as relatively overdosed.ConclusionIn 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
Article number2047487320923185
Pages (from-to)957-965
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number9
Early online date12 May 2020
Publication statusPublished - Sept 2021


  • association
  • carvedilol
  • converting enzyme-inhibitor
  • gender-differences
  • guideline adherence
  • guidelines
  • heart failure
  • heart failure reduced ejection fraction
  • management
  • morbidity
  • population
  • prognosis
  • sex
  • ventricular systolic dysfunction
  • women
  • Heart failure


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