Mitja Lainščak1,2, Ivan Milinković3,4, Marija Polovina3,4, Marisa G Crespo-Leiro5, Lars H Lund6, Stefan D Anker7,8,9, Cécile Laroche10, Roberto Ferrari11,12, Andrew J S Coats13, Theresa McDonagh14, Gerasimos Filippatos15,16, Aldo P Maggioni10,17, Massimo F Piepoli18, Giuseppe M C Rosano19, Frank Ruschitzka20, Dragan Simić3,4, Milika Ašanin3,4, Jean-Christophe Eicher21, Mehmet B Yilmaz22, Petar M Seferović4,23. 1. Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia. 2. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. 3. Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia. 4. Faculty of Medicine, Belgrade University, Belgrade, Serbia. 5. Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain. 6. Heart and Vascular Division, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 7. Division of Cardiology and Metabolism, Department of Cardiology, Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany. 8. German Centre for Cardiovascular Research (Berlin partner site), Charité Universitätsmedizin Berlin, Berlin, Germany. 9. Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany. 10. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 11. Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy. 12. GVM Care and Research, Maria Cecilia Hospital, Cotignola, RA, Italy. 13. Pharmacology Division, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy. 14. Faculty of Life Sciences and Medicine, King's College Hospital, London, UK. 15. Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, Athens, Greece. 16. School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 17. ANMCO Research Centre, Florence, Italy. 18. Heart Failure Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. 19. Cardiovascular and Cell Sciences Institute, King's College Hospital, London, UK. 20. Clinic of Cardiology, University Hospital, Zurich, Switzerland. 21. Department of Cardiology, Rhythmology and Heart Failure Unit, University Hospital François Mitterrand, Dijon, France. 22. Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. 23. Serbian Academy of Sciences and Arts, Belgrade, Serbia.
Abstract
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%.
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 HFpatients 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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