Previous studies have shown that heart failure is associated with worse health-related quality of life (HRQoL). The existence of differences according to gender remains controversial. We studied 1028 consecutive outpatients with heart failure and reduced ejection fraction (HFrEF) from a multicentre cross-sectional descriptive study across Spain that assessed HRQoL using two questionnaires (KCCQ, Kansas City Cardiomyopathy Questionnaire; and EQ-5D, EuroQoL 5 dimensions). The primary objective of the study was to describe differences in HRQoL between men and women in global scores and domains of health status of patients and explore gender differences and its interactions with heart failure related factors. In adjusted analysis women had lower scores in KCCQ overall summary scores when compared to men denoting worse HRQoL (54.7 ± 1.3 vs. 62.7 ± 0.8, p < 0.0001), and specifically got lower score in domains of symptom frequency, symptoms burden, physical limitation, quality of life and social limitation. No differences were found in domains of symptom stability and self-efficacy. Women also had lower scores on all items of EQ-5D (EQ-5D index 0.58 ± 0.01 vs. 0.67 ± 0.01, p < 0.0001). Finally, we analyzed interaction between gender and different clinical determinants regarding the presence of limitations in the 5Q-5D and overall summary score of KCCQ. Interestingly, there was no statistical significance for interaction for any variable. In conclusion, women with HFrEF have worse HRQoL compared to men. These differences do not appear to be mediated by clinical or biological factors classically associated with HRQoL nor with heart failure severity.

Gambling disorder (GD) is a complex mental health condition that can cause many severe psychological, physical, and social impairment. Illegal acts have been recognized in quite a few cases because of the debts related with the gambling activity. This study used network methodology to visualize the relationships among patients seeking treatment for gambling related problems, separately for the patients with and without illegal behaviors. The aim is to identify the diverse and differentiate mechanisms, as well as the central nodes, that occur within GD patients depending on the presence/absence of illegal acts. The sample included N = 401 patients (age range 18 to 80 years). Network analysis was performed considering the nodes that measure gambling features (the core symptoms based on the DSM-5 taxonomy, global symptom severity, and forms of gambling), psychopathology distress, substance use (tobacco, alcohol, and illegal drugs), and personality traits. Two separate networks were adjusted for patients with illegal acts (n = 105) and without these behaviors (n = 296). The most relevant nodes among patients with GD plus illegal acts were self-transcendence and the GD DSM-5 symptom “A7-lies to conceal the extent of gambling” (these variables were also identified as the bridge nodes, those with the highest linkage capacity). Among the patients with GD without illegal acts, the node with the greatest authority was the GD DSM-5 symptom “A5-often gambles when feeling distressed” (this was also the variable with the highest linkage capacity). The study provides empirical evidence of the most relevant features and the linkage capacity among patients seeking treatment for problematic gambling, which can support the development of precise plans for treatment and prevention of the risk of GDRIA.