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Sex differences in early dyspnea relief in the RELAX-AHF study
Literature - Meyer S, Teerlink JR, Metra M, et al. - Clin Res Cardiol. 2017;106(4):280-292


There are important gender-related differences regarding the onset of heart failure (HF), the features of established chronic HF, and the clinical characteristics at admission for acute HF [1,2]. Compared with men, women have more often hypertension, atriumfibrilleren, preserved left ventricle ejection fraction (LVEF), a longer length of hospitalization, and receive less diuretic medication, whereas men are more likely to have a history of myocardial infarction, reduced LVEF, and specific medical and device treatment [3,4].

In this analysis of the RELAX-AHF study [5,6], the gender differences in early and persistent dyspnea relief were investigated. Moreover, patient features and HF characteristics in men and women hospitalized for acute HF were analyzed.

Main results

  • The change in dyspnea visual analog scale AUC from baseline to day 5 did not vary by gender.
  • A significantly higher proportion of women had moderate or marked dyspnea improvement measured by the Likert scale during the first 24 h.
  • There were higher general wellbeing Likert score values in women through 24 h and through 5 days.
  • Women were treated with lower total IV and oral loop diuretic doses through day 5, but dyspnea improved earlier moderately or markedly through day 5 in women.
  • There were no relevant gender differences regarding body weight changes, worsening of HF, or outcomes.
  • Women showed a trend towards longer ICU/CCU stays (4.05 ± 7.67 days vs. 3.51 ± 6.63 days; P = 0.0248) and total initial hospital stays (10.37 ± 9.62 days vs. 9.87 ± 9.17 days; P = 0.0258) compared to men.
  • Physician-assessed signs and symptoms of congestion, such as dyspnea on exertion, orthopnea, edema or rales, did not vary by treatment and gender.
  • Women did not have different outcomes compared with men in any of the analyzed endpoints.
  • The relationship of gender with outcomes did not vary by treatment with serelaxin or the presence of HFpEF.
  • Using a multi-variable logistic regression model, male gender, age and total diuretic dose were independently and negatively associated with dyspnea improvement within 24 h.


In the RELAX-AHF study, women had better early dyspnea relief and improvement in general wellbeing compared with men, even after adjustment for age and LVEF. In-hospital and post-discharge clinical outcomes were similar between men and women.


1. Meyer S, Brouwers FP, Voors AA et al (2015) Sex differences in new-onset heart failure. Clin Res Cardiol 104:342–350

2. Meyer S, Van Der Meer P, Van Deursen VM et al (2013) Neurohormonal and clinical sex differences in heart failure. Eur Heart J 34:2538–2547

3. Meyer S, Van Der Meer P, Hillege HL et al (2013) Sex-specific acute heart failure phenotypes and outcomes from protect. Eur J Heart Fail 15:1374–1381

4. Klein L, Grau-Sepulveda MV, Bonow RO et al (2011) Quality of care and outcomes in women hospitalized for heart failure. Circ Heart Fail 4:589–598

5. Teerlink JR, Cotter G, Davison BA et al (2013) Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 381:29–39

6. Liu LCY, Voors AA, Teerlink JR et al (2016) Effects of serelaxin in acute heart failure patients with renal impairment: results from RELAX-AHF. Clin Res Cardiol 105:727–737

Find this article online at Clin Res Cardiol.

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Schedule24 May 2024