Heart Failure and Women

Heart failure affects about 3.6 million women in the United States. Despite the fact that women account for nearly 50% of all hospital admissions for heart failure, only 25% of women are involved in heart failure studies. Consequently, advances in heart failure therapies apply to most men, but have not been adequately studied in women.

Differences of women with heart failure as compared to men with heart failure:

  • Women tend to develop congestive heart failure at an older age than men.
  • Women tend to develop diastolic heart failure with a more normal ejection fraction than men. Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart. Heart failure can occur due to a weakened heart muscle (systolic heart failure) or may be related to a stiff, inflexible heart muscle (diastolic heart failure). In some cases the ejection fraction can be normal, but due to the increased pressures inside the heart and lungs, the patient can have heart failure. Learn more.
  • The causes of heart failure in women are often linked to high blood pressure, coronary artery disease, valvular disease, and diabetes mellitus.
  • Although rare, peripartum cardiomyopathy is a cause of heart failure unique to women. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy, or within five months after delivery. Peripartum cardiomyopathy occurs without an identifiable cause.
  • Depression is frequently associated with heart failure and is more common in women than men.
  • Although the signs and symptoms of heart failure are the same among men and women, women tend to have more symptoms such as shortness of breath and more difficulty exercising than men.
  • In general, women survive longer than men with heart failure.

Clinical Trials

Heart Failure Clinical Trials and Women


  • Number of Women: 898
  • %Women/Total Patients: 23

Study: SOLVD Treatment

  • Number of Women: 2568
  • %Women/Total Patients: 20

Study: SOLVD Prevention

  • Number of Women: 548
  • %Women/Total Patients:13

Study: RALES

  • Number of Women:446
  • % Women/Total Patients: 27


  • Number of Women: 1918
  • % Women/Total Patients: 29

Study: DIG

  • Number of Women: 1519
  • % Women/Total Patients: 22


  • Number of Women: 515
  • % Women/Total Patients: 19


  • Number of Women: 469
  • % Women/Total Patients: 20

Study: CHARM - Overall

  • Number of Women: 2400
  • % Women/Total Patients: 32

Study: CHARM - Preserved

  • Number of Women: 1212
  • % Women/Total Patients: 40

Study: ELITE - II

  • Number of Women: 966
  • % Women/Total Patients: 31

Study: Val-HEFT

  • Number of Women: 1033
  • % Women/Total Patients: 20


  • Number of Women: 493
  • % Women/Total Patients: 32


  • Number of Women: 145
  • % Women/Total Patients: 32


  • Number of Women: 47
  • % Women/Total Patients: 26

Study: A-HEFT

  • Number of Women: 421
  • % Women/Total Patients: 40

Study: V-HEFT

  • Number of Women: 0
  • % Women/Total Patients: 0

Study: CARE-HF

  • Number of Women: 216
  • % Women/Total Patients: 27

Dr. Eileen Hsich, specialist in Women & Heart Failure

Diastolic Versus Systolic Heart Failure

Women develop diastolic heart failure more often than men, and more frequently than systolic heart failure. Diastolic heart failure occurs when the heart pumps normally, but the ventricles become stiff and doesn't relax properly. This causes the pressure to rise in the heart and lungs. Systolic heart failure occurs when the heart is weak and doesn't contract with enough force. In systolic heart failure there is not enough oxygen-rich blood being pumped throughout the body. The weak heart causes blood to accumulate, leading to a rise in pressure in the heart and lungs very similar to that seen in diastolic heart failure, but due to a different mechanism (ie. weak heart instead of stiff heart).

Causes of Heart Failure Unique to Women

The causes of heart failure in women are different than in men. Women with heart failure are more likely than men to have high blood pressure valvular disease, and diabetes mellitus, and less likely to have congestive heart failure due to prior heart attacks (ischemic cardiomyopathy).

However, women can still develop atherosclerosis (progressive narrowing of the arteries). In fact, although women with congestive heart failure develop coronary artery disease less often then men the frequency is still so high that it is the second leading cause for women with heart failure. It is important to remember that women often have atypical symptoms such as shortness of breath, as compared to men whose primary symptom is often chest pain. Therefore, women like men need to be evaluated for blockages in the arteries.

Women with breast cancer who have been treated with chemotherapy including doxorubicin (Adriamycin) can also develop congestive heart failure due to the toxic effects that these drugs can have on the heart muscle (called drug toxicity).

Another cause of congestive heart failure unique to women is peripartum cardiomyopathy. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy or within five months after delivery. The cause of peripartum cardiomyopathy remains unknown.

Last reviewed by a Cleveland Clinic medical professional on 05/01/2019.


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