Women S Heart Failure Is Different Our Healthcare Must Catch Up

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HEART failure is often seen as a condition that mainly affects men, but this assumption has contributed to a worrying blind spot in women’s health. Millions of women around the world live with heart failure, and many remain unaware of the danger growing quietly within them.
Because their symptoms often do not fit the typical picture of heart disease, women are frequently diagnosed late. By the time the condition is recognised, it may already be advanced and more difficult to treat.
Men often experience heart failure in a way that is visibly dramatic. They report chest tightness, swollen legs or sudden breathlessness. Women, however, tend to notice softer and more confusing signs.
They may feel unusually tired, breathless after light activity or unable to complete daily routines that previously felt easy. These early symptoms can look like stress, lack of sleep or simply the effect of ageing. As a result, women may wait months or even years before seeking help.
This delay is made worse by the fact that doctors also face challenges when interpreting clinical tests in women. Women’s hearts are usually smaller, and their hearts often respond to disease in different ways. What looks normal on a scan may not reflect how unwell a woman actually feels.
Women are much more likely to develop a type of heart failure called heart failure with preserved ejection fraction (HFpEF). This means the heart can pump well enough, but it is too stiff to relax properly. The result is fatigue, breathlessness and a reduced ability to carry out everyday activities even though scans may show normal pumping function.
Several conditions that are common in women increase the risk of HFpEF. High blood pressure, diabetes, obesity and autoimmune diseases all contribute to the problem. Hormonal changes after menopause play an important role too because the drop in estrogen makes the heart more vulnerable to stiffness and inflammation.
Why women need special attention
(Image: iStock)Although women with reduced pumping function often live longer than men with the same condition, women with HFpEF face a different challenge. HFpEF is harder to diagnose and has fewer proven treatments.
Many women with this condition struggle with persistent symptoms that disrupt their daily lives. Hospital admissions are common, and recovery can be slow.
There is, however, progress. A newer class of medication known as SGLT2 inhibitors has been shown to reduce hospitalisation in HFpEF.
Even so, treatment options remain limited. Improving outcomes for women will require medical care that recognises their unique disease patterns rather than relying on knowledge drawn mostly from studies of men.
One of the biggest barriers to better heart care for women is the lack of representation in research. For decades, major heart failure trials have included far fewer women than men. This creates a gap in scientific understanding because the results of these studies shape treatment guidelines used around the world.
When women are not adequately included, the findings may not fully apply to them. Since women respond differently to medication and have different disease patterns, this gap carries real consequences for diagnosis, treatment and long term outcomes.
To give women the best possible care, future studies must include them in meaningful numbers. Policymakers, researchers and funding agencies all have a role to play in correcting this imbalance.
What every woman should know
(Image: Unsplash/Engin Akyurt)Heart failure in women is not simply a copy of the condition seen in men. It is influenced by biology, hormones and life stages that range from pregnancy to menopause. Understanding these differences can help women recognise symptoms earlier and seek care sooner.
Women should pay attention to signs such as persistent fatigue, breathlessness during routine activities, swelling in the legs or ankles, difficulty lying flat without feeling short of breath, and rapid weight gain or fluid retention. These symptoms may feel ordinary, but they should never be ignored.
A useful reminder is that heart failure in women does not always look dramatic. It often looks like everyday tiredness, which is exactly why it is so easily overlooked.
Closing the gap
Raising awareness is only the beginning. Heart failure in women requires earlier recognition, clearer diagnostic strategies and treatment approaches that account for their different disease patterns. Most importantly, women need stronger representation in clinical research so that medical science can offer solutions designed for them.
Heart failure in women is not only a medical concern. It is a public health priority that affects families, communities and the nation’s wellbeing.
By understanding how differently it presents in women and why it often goes unnoticed, we can move closer to a future where every woman receives the timely care she deserves. This understanding can save lives and improve the quality of life for millions. 
Dr Mastura Mohd Sopian is a Family Medicine Specialist and Medical Lecturer at the Department of Clinical Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM), Pulau Pinang

The views expressed are solely of the author and do not necessarily reflect those of  MMKtT.
- Focus Malaysia.

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