Abstract
This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P=0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P<0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years. There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.
Highlights
Heart failure (HF) is a growing health concern affecting more than 26 million patients worldwide.[1, 2] Despite advances in treatment, it accounts for significant proportions of hospitalization, disability and mortality.[3,4,5,6] Chronic HF predominantly affects elderly people; its incidence doubles in men and triples in women with each decade after the age of 65 years.[2]
Of the 16 354 patients enrolled in the ESC HF‐LT Registry between 2011 and 2016, 9428 outpatients with chronic HF were included in the present analysis
The present study provides important information on age‐ and sex‐related differences in the clinical presentation, management and outcomes of chronic HF in a large, multinational cohort of ambulatory patients included in the ESC HF‐LT Registry
Summary
Heart failure (HF) is a growing health concern affecting more than 26 million patients worldwide.[1, 2] Despite advances in treatment, it accounts for significant proportions of hospitalization, disability and mortality.[3,4,5,6] Chronic HF predominantly affects elderly people; its incidence doubles in men and triples in women with each decade after the age of 65 years.[2]. With respect to HF treatment, a tendency for the underutilization or suboptimal dosing of guideline‐ directed medical therapy (GDMT) in women and elderly patients compared to men and younger patients has been shown. Women with HF receive beta‐blockers (BBs) and angiotensin‐converting enzyme inhibitors (ACEIs) less frequently, and at lower than recommended dosages, than men.[13,14,15] One study has suggested a sex‐specific bias in the choice of HF medication in relation to the health care provider's specialty (cardiologist vs non‐cardiologist).[16] In addition, suboptimal dosing of ACEIs and BBs has been reported in elderly HF patients.[17,18,19] These factors may contribute to the reported lesser improvements in functional status, quality of life and survival with GDMT in women and elderly patients with chronic HF.[20, 21]
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