SynthesisEuropean heart journal2026
Sex differences in pharmacological treatment of heart failure: a meta-analysis of randomized trials.
Synthesis in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
BACKGROUND AND
aimsWomen remain underrepresented in heart failure (HF) trials, raising concerns about potential undetected sex-specific differences in treatment efficacy. This study assesses sex differences in the primary efficacy endpoint of HF treatments and examines whether the proportion of women enrolled in a trial influences (variations in) treatment effect estimates.
methodsA systematic search was conducted up to 21 March 2025, including randomized controlled trials (RCTs) (≥100 patients) evaluating pharmacological HF treatments vs. placebo or usual care, with clinical events as the primary outcome. Sex differences in the primary outcome were assessed using a random-effects meta-analysis of the reported relative effect measures (REM) and pooled estimates. For key clinical outcomes, meta-regression analyses were performed to examine the association between the proportion of women enrolled and sex differences in REMs, as well as the overall REMs without separating sex.
resultsOf 5749 screened publications, 139 RCTs met inclusion criteria, with 292 027 patients (28.1% women). Based on 78 RCTs that reported sex-stratified treatment effects, pooled analysis showed no difference in treatment efficacy between women and men (delta ln[REM] 0.00; 95% confidence interval (CI) -0.04 to 0.03; P = .85; I2 = 4.1%). Meta-regression found no association between the proportion of women and sex differences in REM (78 RCTs, P = .25), overall efficacy (139 RCTs, P = .24), or other clinical outcomes.
conclusionsThese findings suggest that pharmacological efficacy in HF does not differ by sex and that historical female underrepresentation in trials is unlikely to have masked important sex differences. Nonetheless, improving sex balance in HF trials remains essential for societal and ethical reasons.
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Registered trials
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