TY - JOUR
T1 - Sex- and age-related differences in the management and outcomes of chronic heart failure
T2 - an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry
AU - on behalf of the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group
AU - Lainščak, Mitja
AU - Milinković, Ivan
AU - Polovina, Marija
AU - Crespo-Leiro, Marisa G.
AU - Lund, Lars H.
AU - Anker, Stefan D.
AU - Laroche, Cécile
AU - Ferrari, Roberto
AU - Coats, Andrew J.S.
AU - McDonagh, Theresa
AU - Filippatos, Gerasimos
AU - Maggioni, Aldo P.
AU - Piepoli, Massimo F.
AU - Rosano, Giuseppe M.C.
AU - Ruschitzka, Frank
AU - Simić, Dragan
AU - Ašanin, Milika
AU - Eicher, Jean Christophe
AU - Yilmaz, Mehmet B.
AU - Seferović, Petar M.
AU - Gale, Christopher Peter
AU - Chair, G. B.
AU - Branko Beleslin, R. S.
AU - Andrzej Budaj, P. L.
AU - Ovidiu Chioncel, R. O.
AU - Ferrari, R.
AU - Maggioni, A. P.
AU - Romano, S.
AU - Marcon, S.
AU - Di Mauro, M.
AU - Lombardi, C.
AU - Barbieri, A.
AU - Ferrari, R.
AU - Musio, S.
AU - Correale, M.
AU - Zanelli, E.
AU - Giordano, A.
AU - Agostoni, P.
AU - Italiano, G.
AU - Salvioni, E.
AU - Priori, S. G.
AU - Cattaneo, S.
AU - Opasich, C.
AU - Gualco, A.
AU - Cinque, A.
AU - Sergi, D.
AU - Marchese, G.
AU - Placido, R.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Aims: 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. Methods and results: 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. Conclusions: 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%.
AB - Aims: 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. Methods and results: 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. Conclusions: 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%.
KW - Age
KW - Hospitalization
KW - Mortality
KW - Registry
KW - Sex
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U2 - 10.1002/ejhf.1645
DO - 10.1002/ejhf.1645
M3 - Article
AN - SCOPUS:85076898519
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
ER -