Penn Research Highlights Treatment Differences for Men and Women
Intriguing Results, Stemming From the Largest Study Ever of Female Heart Failure Patients Who Underwent a Specialized Stress Test, Could Raise Larger Questions about Gender Differences and Treatment Options
Researchers at the University of Pennsylvania School of Medicine concluded that women tend to have lower maximum exercise oxygen uptake (VO2) levels than men, yet their survival is significantly better than men. In the largest study to date of female heart failure patients undergoing specialized stress testing, results suggest that instead of one standard level for both men and women, perhaps there should be a lower cut-off level for women. This would allow physicians to avoid more advanced therapies in some female heart failure patients. The study results are published in the June 6th issue of the Journal of the American College of Cardiology.
“Heart failure cardiologists utilize this special kind of exercise test, which examines your body's ability to utilize oxygen during maximal exercise, to determine a course of treatment for our patients. Up until now, there has been one absolute cut-off level, based on VO2 stress test results, for both men and women. It's been the ‘gold standard' for us to decide the risk of proceeding with a treatment like transplant, ventricular-assist devices or other therapies,” said Mariell Jessup, MD , Medical Director of the Heart Failure and Transplant program and Professor of Medicine at Penn.
The VO2 is an exercise test in which a patient walks on a treadmill. A mouthpiece measures the amount of oxygen the body is using during exercise to determine how well the heart muscle is delivering oxygen to the muscles of the body in order to do work. The results help cardiologists decide which advanced treatments to consider for their patients. Patients with results below the standard cut-off level may be considered for a heart transplant or ventricular-assist device.
“The physician must consider the risk of the therapy versus the risk of keeping what the patient already has. Of all the things we do, the maximal VO2 is the most potent predictor. We decided to look at what happened to these patients, both men and women, after they had the VO2 stress test done, to see how many of them went on to receive a heart transplant and how many did not survive,” explains Lee Goldberg, MD, MPH, an investigator in the study and Associate Director of the Heart Failure and Transplant program at Penn.
“There have been other studies suggesting the outcome for women with heart failure is better than men. We took that one step further, and for the first time, went back to investigate the outcomes of male and female patients based on what their VO2 stress test result had been. Now, the question is - if the VO2 is the main determinant for prognosis in heart failure, we need to make sure we're using the right cut-off for both genders.”
Investigators caution that while we now know there are gender differences to consider in determining treatment in heart failure patients, much more research remains to be done in this area.
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