Understanding sexual health trajectories in patients with heart failure: a longitudinal analysis

Sexual health is a key component of overall well-being, including physical, emotional, mental, and social aspects. Many patients with heart failure (HF) experience sexual health problems. Understanding their prevalence, persistence, and predictors of sexual health difficulties is essential for holistic care.

To describe the trajectory of sexual health difficulties over one year in patients with HF and identify related factors.

Data were drawn from the international HF-Wii RCT study. For this analysis we used data of 373 patients with complete data on sexual health at baseline, 3, 6, and 12 months. Sexual health was measured using one item from the Minnesota Living with Heart Failure questionnaire: "Did your heart failure prevent you from living as you wanted during the past month by making your sexual activities difficult?" (0 = no difficulties; 5 = very much difficulties). For each time point, patients scoring 0 were classified as having no sexual difficulties, and those scoring 1–5 were classified as experiencing sexual difficulties. Over time, patients were grouped as having no sexual difficulties (0–1 occurrence) or recurrent sexual difficulties (2–4 occurrences) (Figure 1). Baseline demographic and clinical data were collected. Depression and anxiety were measured with the Hospital Anxiety and Depression scale; well-being with Cantril’s Ladder; sleep difficulties with the Minimal Insomnia Symptom Scale. Univariate tests assessed group differences. Variables with p<0.05 were included in logistic regression to identify predictors.

Of 373 patients (mean age 66 ± 12; 27% women), 76% were married/in a relationship; 72% NYHA I/II; At baseline, 66% (n=245) of the patients’ reported sexual difficulties. Among these, 7% only experienced sexual difficulties at baseline, 64% experienced sexual difficulties at all follow-ups, and 29% reported difficulties at 2–3 follow-ups. Of those without difficulties at baseline (n=128, 34%), 50% did not experience sexual difficulties over the 1-year period, 15% reported difficulties at all follow-ups, and 35% at 2–3 follow-ups (Figure 2).

Recurrent sexual difficulties were associated with male gender (OR 4.98, p < .001), experience symptoms of anxiety (OR 3.29 p=.002), being married/in a relationship (OR 2.24, p=.003), higher NYHA class (OR 2.021, p=.005), experiencing symptoms of depression (OR 3.514, p=.017), and having diabetes (OR 2.22, p=.029). The variance was explained by 31%.

Sexual difficulties were highly prevalent and often recurred over time, with nearly two-thirds of patients experiencing them at all follow-ups. Male gender, relationship status, psychological symptoms, higher NYHA class, and diabetes significantly increased the likelihood of persistent sexual difficulties. Routine assessment and open discussions of sexual health should be integrated into cardiac care, especially for high-risk patients, to improve wellbeing in heart failure.Fig 1.

Scoring of sexual difficulties