Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 22, Issue 1, Pages 92-102Publisher
WILEY
DOI: 10.1002/ejhf.1645
Keywords
Age; Sex; Mortality; Hospitalization; Registry
Categories
Funding
- Abbott Vascular International
- Amgen Cardiovascular
- AstraZeneca
- Bayer AG
- Boehringer Ingelheim
- Boston Scientific
- Bristol-Myers Squibb
- Pfizer Alliance
- Daiichi Sankyo Europe GmbH
- Eli Lilly & Company Alliance
- Edwards
- Gedeon Richter
- Menarini International Operations
- MSD-Merck Co.
- Novartis Pharma AG
- ResMed
- Sanofi
- Servier
- Vifor
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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%.
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